High-Risk Aortic Valve Replacement: Are the Outcomes as Bad as Predicted?

Eugene A. Grossi, Charles F. Schwartz, Pey Jen Yu, Ulrich P. Jorde, Gregory A. Crooke, Juan B. Grau, Greg H. Ribakove, F. Gregory Baumann, Patricia Ursumanno, Alfred T. Culliford, Stephen B. Colvin, Aubrey C. Galloway

Research output: Contribution to journalArticle

188 Citations (Scopus)

Abstract

Background: Percutaneous aortic valve replacement (PAVR) trials are ongoing in patients with an elevated European System for Cardiac Operative Risk Evaluation (EuroSCOREs), patients believed to have high mortality rates and poor long-term prognoses with valve replacement surgery. It is, however, uncertain that the EuroSCORE model is well calibrated for such high-risk AVR patients. We evaluated EuroSCORE prediction vs a single institution's surgical results in this target population. Methods: From January 1996 through March 2006, 731 patients with EuroSCOREs of 7 or higher underwent isolated AVR. In this cohort, 313 (42.8%) were septuagenarians, 322 (44.0%) were octogenarians or nonagenarians, 233 (31.9%) had had previous cardiac procedures, 237 (32.4%) had atheromatous aortas, and 127 (17.4%) had cerebrovascular disease. A minimally invasive approach was used in 469 (64.2%). Data collection was prospective. Long-term survival was computed from the Social Security Death Benefit Index. Results: The mean EuroSCORE was 9.7 (median, 10), and the mean logistic EuroSCORE was 17.2%. Actual hospital mortality was 7.8% (57 of 731). Multivariate analysis showed ejection fraction of less than 0.30 (p = 0.002; odds ratio [OR], 3.13), chronic obstructive pulmonary disease (p = 0.019; OR, 2.14), and peripheral vascular disease (p = 0.048; OR, 2.13) were significant predictors of hospital mortality. Complication(s) occurred in 73 patients (9.9%). Freedom from all-cause death (including hospital mortality) was 72.4% at 5 years (n = 152). Age (p < 0.001), previous cardiac operations (p < 0.014; OR, 1.51), renal failure (p < 0.002; OR, 2.37), and chronic obstructive pulmonary disease (p < 0.007; OR, 1.30) were predictors of worse survival. Conclusions: Logistic EuroSCORE greatly overpredicts mortality in these patients. Five-year survival is good, unlike suggestions from earlier EuroSCORE analyses. This raises concern about unknown long-term percutaneous prosthesis function. Clinical trials for these patients must include randomized surgical controls and have long-term end points.

Original languageEnglish (US)
Pages (from-to)102-107
Number of pages6
JournalAnnals of Thoracic Surgery
Volume85
Issue number1
DOIs
StatePublished - Jan 2008
Externally publishedYes

Fingerprint

Aortic Valve
Odds Ratio
Hospital Mortality
Chronic Obstructive Pulmonary Disease
Survival
Cerebrovascular Disorders
Peripheral Vascular Diseases
Mortality
Social Security
Health Services Needs and Demand
Prostheses and Implants
Renal Insufficiency
Aorta
Cause of Death
Multivariate Analysis
Clinical Trials

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Grossi, E. A., Schwartz, C. F., Yu, P. J., Jorde, U. P., Crooke, G. A., Grau, J. B., ... Galloway, A. C. (2008). High-Risk Aortic Valve Replacement: Are the Outcomes as Bad as Predicted? Annals of Thoracic Surgery, 85(1), 102-107. https://doi.org/10.1016/j.athoracsur.2007.05.010

High-Risk Aortic Valve Replacement : Are the Outcomes as Bad as Predicted? / Grossi, Eugene A.; Schwartz, Charles F.; Yu, Pey Jen; Jorde, Ulrich P.; Crooke, Gregory A.; Grau, Juan B.; Ribakove, Greg H.; Baumann, F. Gregory; Ursumanno, Patricia; Culliford, Alfred T.; Colvin, Stephen B.; Galloway, Aubrey C.

In: Annals of Thoracic Surgery, Vol. 85, No. 1, 01.2008, p. 102-107.

Research output: Contribution to journalArticle

Grossi, EA, Schwartz, CF, Yu, PJ, Jorde, UP, Crooke, GA, Grau, JB, Ribakove, GH, Baumann, FG, Ursumanno, P, Culliford, AT, Colvin, SB & Galloway, AC 2008, 'High-Risk Aortic Valve Replacement: Are the Outcomes as Bad as Predicted?', Annals of Thoracic Surgery, vol. 85, no. 1, pp. 102-107. https://doi.org/10.1016/j.athoracsur.2007.05.010
Grossi, Eugene A. ; Schwartz, Charles F. ; Yu, Pey Jen ; Jorde, Ulrich P. ; Crooke, Gregory A. ; Grau, Juan B. ; Ribakove, Greg H. ; Baumann, F. Gregory ; Ursumanno, Patricia ; Culliford, Alfred T. ; Colvin, Stephen B. ; Galloway, Aubrey C. / High-Risk Aortic Valve Replacement : Are the Outcomes as Bad as Predicted?. In: Annals of Thoracic Surgery. 2008 ; Vol. 85, No. 1. pp. 102-107.
@article{df36bd370a8b47cfb9fd2e8e33b388ca,
title = "High-Risk Aortic Valve Replacement: Are the Outcomes as Bad as Predicted?",
abstract = "Background: Percutaneous aortic valve replacement (PAVR) trials are ongoing in patients with an elevated European System for Cardiac Operative Risk Evaluation (EuroSCOREs), patients believed to have high mortality rates and poor long-term prognoses with valve replacement surgery. It is, however, uncertain that the EuroSCORE model is well calibrated for such high-risk AVR patients. We evaluated EuroSCORE prediction vs a single institution's surgical results in this target population. Methods: From January 1996 through March 2006, 731 patients with EuroSCOREs of 7 or higher underwent isolated AVR. In this cohort, 313 (42.8{\%}) were septuagenarians, 322 (44.0{\%}) were octogenarians or nonagenarians, 233 (31.9{\%}) had had previous cardiac procedures, 237 (32.4{\%}) had atheromatous aortas, and 127 (17.4{\%}) had cerebrovascular disease. A minimally invasive approach was used in 469 (64.2{\%}). Data collection was prospective. Long-term survival was computed from the Social Security Death Benefit Index. Results: The mean EuroSCORE was 9.7 (median, 10), and the mean logistic EuroSCORE was 17.2{\%}. Actual hospital mortality was 7.8{\%} (57 of 731). Multivariate analysis showed ejection fraction of less than 0.30 (p = 0.002; odds ratio [OR], 3.13), chronic obstructive pulmonary disease (p = 0.019; OR, 2.14), and peripheral vascular disease (p = 0.048; OR, 2.13) were significant predictors of hospital mortality. Complication(s) occurred in 73 patients (9.9{\%}). Freedom from all-cause death (including hospital mortality) was 72.4{\%} at 5 years (n = 152). Age (p < 0.001), previous cardiac operations (p < 0.014; OR, 1.51), renal failure (p < 0.002; OR, 2.37), and chronic obstructive pulmonary disease (p < 0.007; OR, 1.30) were predictors of worse survival. Conclusions: Logistic EuroSCORE greatly overpredicts mortality in these patients. Five-year survival is good, unlike suggestions from earlier EuroSCORE analyses. This raises concern about unknown long-term percutaneous prosthesis function. Clinical trials for these patients must include randomized surgical controls and have long-term end points.",
author = "Grossi, {Eugene A.} and Schwartz, {Charles F.} and Yu, {Pey Jen} and Jorde, {Ulrich P.} and Crooke, {Gregory A.} and Grau, {Juan B.} and Ribakove, {Greg H.} and Baumann, {F. Gregory} and Patricia Ursumanno and Culliford, {Alfred T.} and Colvin, {Stephen B.} and Galloway, {Aubrey C.}",
year = "2008",
month = "1",
doi = "10.1016/j.athoracsur.2007.05.010",
language = "English (US)",
volume = "85",
pages = "102--107",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "1",

}

TY - JOUR

T1 - High-Risk Aortic Valve Replacement

T2 - Are the Outcomes as Bad as Predicted?

AU - Grossi, Eugene A.

AU - Schwartz, Charles F.

AU - Yu, Pey Jen

AU - Jorde, Ulrich P.

AU - Crooke, Gregory A.

AU - Grau, Juan B.

AU - Ribakove, Greg H.

AU - Baumann, F. Gregory

AU - Ursumanno, Patricia

AU - Culliford, Alfred T.

AU - Colvin, Stephen B.

AU - Galloway, Aubrey C.

PY - 2008/1

Y1 - 2008/1

N2 - Background: Percutaneous aortic valve replacement (PAVR) trials are ongoing in patients with an elevated European System for Cardiac Operative Risk Evaluation (EuroSCOREs), patients believed to have high mortality rates and poor long-term prognoses with valve replacement surgery. It is, however, uncertain that the EuroSCORE model is well calibrated for such high-risk AVR patients. We evaluated EuroSCORE prediction vs a single institution's surgical results in this target population. Methods: From January 1996 through March 2006, 731 patients with EuroSCOREs of 7 or higher underwent isolated AVR. In this cohort, 313 (42.8%) were septuagenarians, 322 (44.0%) were octogenarians or nonagenarians, 233 (31.9%) had had previous cardiac procedures, 237 (32.4%) had atheromatous aortas, and 127 (17.4%) had cerebrovascular disease. A minimally invasive approach was used in 469 (64.2%). Data collection was prospective. Long-term survival was computed from the Social Security Death Benefit Index. Results: The mean EuroSCORE was 9.7 (median, 10), and the mean logistic EuroSCORE was 17.2%. Actual hospital mortality was 7.8% (57 of 731). Multivariate analysis showed ejection fraction of less than 0.30 (p = 0.002; odds ratio [OR], 3.13), chronic obstructive pulmonary disease (p = 0.019; OR, 2.14), and peripheral vascular disease (p = 0.048; OR, 2.13) were significant predictors of hospital mortality. Complication(s) occurred in 73 patients (9.9%). Freedom from all-cause death (including hospital mortality) was 72.4% at 5 years (n = 152). Age (p < 0.001), previous cardiac operations (p < 0.014; OR, 1.51), renal failure (p < 0.002; OR, 2.37), and chronic obstructive pulmonary disease (p < 0.007; OR, 1.30) were predictors of worse survival. Conclusions: Logistic EuroSCORE greatly overpredicts mortality in these patients. Five-year survival is good, unlike suggestions from earlier EuroSCORE analyses. This raises concern about unknown long-term percutaneous prosthesis function. Clinical trials for these patients must include randomized surgical controls and have long-term end points.

AB - Background: Percutaneous aortic valve replacement (PAVR) trials are ongoing in patients with an elevated European System for Cardiac Operative Risk Evaluation (EuroSCOREs), patients believed to have high mortality rates and poor long-term prognoses with valve replacement surgery. It is, however, uncertain that the EuroSCORE model is well calibrated for such high-risk AVR patients. We evaluated EuroSCORE prediction vs a single institution's surgical results in this target population. Methods: From January 1996 through March 2006, 731 patients with EuroSCOREs of 7 or higher underwent isolated AVR. In this cohort, 313 (42.8%) were septuagenarians, 322 (44.0%) were octogenarians or nonagenarians, 233 (31.9%) had had previous cardiac procedures, 237 (32.4%) had atheromatous aortas, and 127 (17.4%) had cerebrovascular disease. A minimally invasive approach was used in 469 (64.2%). Data collection was prospective. Long-term survival was computed from the Social Security Death Benefit Index. Results: The mean EuroSCORE was 9.7 (median, 10), and the mean logistic EuroSCORE was 17.2%. Actual hospital mortality was 7.8% (57 of 731). Multivariate analysis showed ejection fraction of less than 0.30 (p = 0.002; odds ratio [OR], 3.13), chronic obstructive pulmonary disease (p = 0.019; OR, 2.14), and peripheral vascular disease (p = 0.048; OR, 2.13) were significant predictors of hospital mortality. Complication(s) occurred in 73 patients (9.9%). Freedom from all-cause death (including hospital mortality) was 72.4% at 5 years (n = 152). Age (p < 0.001), previous cardiac operations (p < 0.014; OR, 1.51), renal failure (p < 0.002; OR, 2.37), and chronic obstructive pulmonary disease (p < 0.007; OR, 1.30) were predictors of worse survival. Conclusions: Logistic EuroSCORE greatly overpredicts mortality in these patients. Five-year survival is good, unlike suggestions from earlier EuroSCORE analyses. This raises concern about unknown long-term percutaneous prosthesis function. Clinical trials for these patients must include randomized surgical controls and have long-term end points.

UR - http://www.scopus.com/inward/record.url?scp=37249022337&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=37249022337&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2007.05.010

DO - 10.1016/j.athoracsur.2007.05.010

M3 - Article

C2 - 18154791

AN - SCOPUS:37249022337

VL - 85

SP - 102

EP - 107

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 1

ER -