Thorac Cardiovasc Surg 2014; 62 - OP164
DOI: 10.1055/s-0034-1367238

Acute decompensated aortic and mitral valve disease: Short and long-term operative outcomes

S. Leontyev 1, P. Davierwala 1, M. Misfeld 1, F. Bakhtiary 1, D. Holzhey 1, K. Röhrig 1, M.A. Borger 1, F.W. Mohr 1
  • 1Herzzentrum Leipzig, Herzchirurgie, Leipzig, Germany

Objective: Early and late outcomes in patients undergoing surgery for acute decompensated aortic or mitral valve disease (ADVD) are not well described. The aim of this study was to evaluate the early and long-term results after surgical treatment of patients with ADVD.

Methods: Between 04/95 and 06/10, 1042 patients underwent surgery for ADVD in our institution. Acute decompensation was defined as patients presenting with dyspnoea or tachycardia with pulmonary congestion or oedema, and/or cardiogenic shock. Mean age was 64 ± 14 years; 37.7% were female. On admission, 17% of patients were in cardiogenic shock, 27% required inotropic support, and 11% were intubated. Eight percent of patients required cardiopulmonary resuscitation (CPR) prior to surgery. Acute endocarditis was the primary indication for surgery in 66% of patients. All patients underwent urgent (22%) or emergent (78%) surgery.

Multivariate logistic and Cox regression analyses identified the predictors of 30-day and late mortality, respectively.

Results: Overall 30-day mortality was 18.6%. Multivariate analysis identified preoperative cardiogenic shock (Odds ratio [OR]: 2.3; p < 0.001 95% CI:1.6-3.6), preoperative inotrope use (OR:1.8; p = 0.002 95% CI :1.2-2.6), CPR (OR: 2.3; p = 0.002, 95% CI: 1.4 - 4.2), preoperative dialysis (OR: 2.8; p = 0.003 95% CI : 1.4 - 5.6) and coronary artery disease (OR: 1.8; p = 0.01; 95% CI: 1.1 - 2.9). Cox regression analysis revealed age, diabetes, COPD, NYHA class IV, active endocarditis, peripheral vascular disease, and preoperative dialysis to be independent predictors of long-term mortality, in addition to the perioperative predictors listed above. Mean survival at 5 and 10 years was 53 ± 1% and 32 ± 2%, respectively with an estimated mean survival of 6.4 ± 0.2 years.

Conclusions: Surgery for ADVD is associated with a relatively high early mortality rate, but satisfactory long-term survial. Preoperative inotrope use, cardiogenic shock, CPR, coronary artery disease and previous cardiac surgery predict both 30-day and long-term mortality.