TY - JOUR
T1 - Small prosthesis size in aortic valve replacement does not affect mortality
AU - Lapar, Damien J.
AU - Ailawadi, Gorav
AU - Bhamidipati, Castigliano M.
AU - Stukenborg, George
AU - Crosby, Ivan K.
AU - Kern, John A.
AU - Kron, Irving L.
N1 - Funding Information:
We thank Curtis Klann of the University of Virginia and Eddie Fonner of the ARMUS Corporation for their assistance with data gathering. This study was supported by National Heart, Lung, And Blood Institute grant 2T32HL007849-11A1 to Drs LaPar and Bhamidipati and by a research grant from the Thoracic Surgery Foundation for Research and Education to Dr Ailawasi. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of either the National Heart, Lung, and Blood Institute or the National Institutes of Health.
PY - 2011/9
Y1 - 2011/9
N2 - Background: Small prosthesis size has been associated with poorer postoperative outcomes in aortic valve replacement (AVR). We hypothesized that the use of small aortic valve (AV) prostheses does not independently increase operative mortality following AVR, but that mortality may instead be related to comorbidities. Methods: We examined the mortality among 4,621 patients who underwent primary AVR operations at 13 different statewide centers from 2003 to 2008. Patients were stratified by prosthesis size into groups with small (≤ 21 mm, n = 1,810) and standard AV prostheses (< 23 mm, n = 2,811). The effect of prosthesis size on outcomes was evaluated with univariate and multivariable regression analyses. Results: Operative mortality among patients undergoing primary AVR operations was 3.7%. Among isolated operations, small AV prostheses were implanted in more females (79.9% vs 21.0%, p < 0.001) and older patients (68.9 ± 12.3 years vs 63.8 ± 13.9 years, p < 0.001) than were standard-size AV prostheses, and carried a higher predicted risk of mortality according to the Society of Thoracic Surgeons Predicted Risk of Mortality Score (3.1 [interquartile range, 3.0] versus 2.2 [2.0], p < 0.001) than did standard-size AV prostheses. Small AV prostheses incurred more major complications (19.5% vs 15.7%, p = 0.01), a greater mortality (3.9% vs 2.3%, p = 0.03), a longer postoperative length of stay (6.0 [3.0] vs 5.0 [3.0] days, p < 0.001), and higher total costs ($29,738 [18,196] vs $26,679 [14,890], p < 0.001) than did standard AV prostheses. However, when analyzed with multivariate regression, small AV prosthesis size and female gender were not independent predictors of operative mortality, whereas advanced age, cardiopulmonary bypass time, and aortic annular enlargement were important predictors of operative mortality. Conclusions: Small aortic valve prosthesis size does not independently increase operative mortality following primary AVR. Increased morbidity and mortality among patients undergoing the implantation of small AV prostheses is related to the confounding effects of preoperative and operative risk factors. Annular enlargement may not always reduce mortality.
AB - Background: Small prosthesis size has been associated with poorer postoperative outcomes in aortic valve replacement (AVR). We hypothesized that the use of small aortic valve (AV) prostheses does not independently increase operative mortality following AVR, but that mortality may instead be related to comorbidities. Methods: We examined the mortality among 4,621 patients who underwent primary AVR operations at 13 different statewide centers from 2003 to 2008. Patients were stratified by prosthesis size into groups with small (≤ 21 mm, n = 1,810) and standard AV prostheses (< 23 mm, n = 2,811). The effect of prosthesis size on outcomes was evaluated with univariate and multivariable regression analyses. Results: Operative mortality among patients undergoing primary AVR operations was 3.7%. Among isolated operations, small AV prostheses were implanted in more females (79.9% vs 21.0%, p < 0.001) and older patients (68.9 ± 12.3 years vs 63.8 ± 13.9 years, p < 0.001) than were standard-size AV prostheses, and carried a higher predicted risk of mortality according to the Society of Thoracic Surgeons Predicted Risk of Mortality Score (3.1 [interquartile range, 3.0] versus 2.2 [2.0], p < 0.001) than did standard-size AV prostheses. Small AV prostheses incurred more major complications (19.5% vs 15.7%, p = 0.01), a greater mortality (3.9% vs 2.3%, p = 0.03), a longer postoperative length of stay (6.0 [3.0] vs 5.0 [3.0] days, p < 0.001), and higher total costs ($29,738 [18,196] vs $26,679 [14,890], p < 0.001) than did standard AV prostheses. However, when analyzed with multivariate regression, small AV prosthesis size and female gender were not independent predictors of operative mortality, whereas advanced age, cardiopulmonary bypass time, and aortic annular enlargement were important predictors of operative mortality. Conclusions: Small aortic valve prosthesis size does not independently increase operative mortality following primary AVR. Increased morbidity and mortality among patients undergoing the implantation of small AV prostheses is related to the confounding effects of preoperative and operative risk factors. Annular enlargement may not always reduce mortality.
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U2 - 10.1016/j.athoracsur.2011.04.105
DO - 10.1016/j.athoracsur.2011.04.105
M3 - Article
C2 - 21871273
AN - SCOPUS:80052809983
SN - 0003-4975
VL - 92
SP - 880
EP - 888
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 3
ER -