Original article
Cardiovascular
Long-Term Consequences of Postoperative Heart Failure After Surgery for Aortic Stenosis Compared With Coronary Surgery

https://doi.org/10.1016/j.athoracsur.2007.01.031Get rights and content

Background

Although postoperative heart failure is a major determinant of operative mortality in cardiac surgery it has received little attention in the literature, and long-term consequences remain to be addressed. Therefore, the impact of postoperative heart failure on long-term survival in relation to other risk factors was studied.

Methods

All patients undergoing aortic valve replacement (AVR) for aortic stenosis from 1995 through 2000 in the southeast region of Sweden (n = 398) were compared with a cohort, matched for age and sex, undergoing coronary artery bypass grafting (CABG [n = 398]). Risk factors for 5-year mortality were analyzed.

Results

Forty-five AVR and 47 CABG patients required treatment for postoperative heart failure. Thirty-day, 1-year, and 5-year mortality in patients with and without postoperative heart failure after AVR were 6.7% versus 1.4% (p = 0.05), 8.9% versus 4.0% (p = 0.13), and 42.2% versus 14.2% (p < 0.0001) respectively. Corresponding results in the CABG group were 21.3% versus 1.1% (p < 0.0001), 25.5% versus 3.1% (p < 0.0001), and 36.2% versus 11.1% (p = 0.0015). Postoperative heart failure, preoperative renal dysfunction, procedure-associated stroke, body mass index less than 19 kg/m2, older age, preoperative atrial fibrillation, and preoperative anemia turned out as independent risk factors for 5-year mortality after AVR. In the CABG group, postoperative heart failure, diabetes mellitus, older age, and procedure-associated stroke emerged as independent risk factor for 5-year mortality.

Conclusions

Postoperative heart failure was associated with high early mortality after CABG whereas the grave consequences of postoperative heart failure after AVR for aortic stenosis became evident only with time.

Section snippets

Patients

The University Hospital in Linköping is the only referral center in the southeast region of Sweden, serving a population of approximately 1 million. From 1995 through 2000, 4,806 patients underwent cardiac surgery. There were 398 patients operated on who had isolated AVR because of aortic stenosis, without clinically significant regurgitation or significant coronary artery disease. To account for evident differences regarding age and sex distribution, these patients were compared with a cohort

Clinical Baseline Characteristics

The average age of AVR and CABG patients was 70 ± 10 years and 48% were female in both cohorts. In AVR patients, the average valve orifice area was 0.61 ± 0.19 cm2, and 7.8% of the procedures were urgent or emergent. The EuroSCORE (European System for Cardiac Operative Risk Evaluation) was 5.5 ± 2.2, and 30-day mortality was 2.0%. Further details are given in Table 1.

Preoperative demographics in the CABG group included a prevalence of diabetes mellitus (insulin or orally treated) of 19.3%,

Comment

The survival curves and risk factor analyses demonstrate that PHF was a serious complication with a high early mortality after CABG, whereas its influence on late mortality was minor in comparison with other risk factors. In contrast, PHF had a less obvious impact on early mortality after AVR for aortic stenosis, but owing to a sustained negative effect on survival, PHF patients had an equally profound 5-year mortality in both groups.

The valve patients studied represented the largest homogenous

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    Copyright © 2007 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.