Surgical Aortic Valve Replacement: Performance And Outcomes In Patients With Pre-existing Comorbidities
Farhad Bakhtiary1, Ali El-Sayed Ahmad2, Andreas Ziegler3, Nikolaos Bonaros4, Hans-Joachim Geissler5, Oliver Dewald6, Arash Mehdiani7, Francesco Pollari8.
1University Hospital Bonn, Bonn, Germany, 2Heart Center Siegburg, Siegburg, Germany, 3Kepler University Hospital Linz, Linz, Austria, 4Medical University of Innsbruck, Innsbruck, Austria, 5Hospital Wels-Grieskirchen, Wels-Grieskirchen, Austria, 6University Hospital Oldenburg, Oldenburg, Germany, 7University Hospital Duesseldorf, Duesseldorf, Germany, 8Nuremberg South Hospital, Nuremberg, Germany.
Objectives: Performance and outcomes after surgical aortic valve replacements (SAVR) are thought to be affected by comorbidities as chronic kidney disease (CKD), hypertension (HTN), diabetes, metabolic syndrome (MS).
Methods: IMPACT is a prospective, 5-year FU, multicenter, echocardiography corelab supported registry in patients undergoing SAVR with a novel bioprosthetic valve. We aim to determine all-cause and valve-related mortality and hemodynamic performance, overall and by pre-defined comorbidities.
Results: From 2019-2021, 564 patients aged 63.4±8.6 years, 28.9% female, 40.7% NYHA III/IV and STS 1.7±2.2% were enrolled in 21 sites. 66.0% had HTN, 18.6% diabetes, 15.6% CKD and 7.4% MS. In CKD, age (67.2 years) and the proportion of females (44.3%) were highest. Patients with MS had the highest BMI (33.1kg/m2) and STS (3.4±4.7%). 53.3% of patients with diabetes were NYHA III/IV. Overall, 43.6% had bicuspid valves, 58.5% underwent isolated AVR and 16.5% combined with CABG. Minimally invasive AVR was common (51%). Post-procedural, mean PG was 11.4±6.3 mmHg, EOA 2.0±0.6 cm2. PVL was rare with two cases of moderate PVL (0.4%), one due to endocarditis. Immediate procedural mortality was 0.5% (n=3). Hemodynamic outcomes were similar across comorbidities with the 3 patients expired suffering from hypertension or diabetes. Length of stay on ICU was 24 hours (IQR 21-48) with a hospitalization of 8 days (IQR 7-12). All-cause mortality was 1.4% until discharge (n=8). Four patients underwent repeat procedure, 14 (2.6%) suffered from stroke/TIA, and pacemaker implantation was required in 26 patients (4.8%). Mortality rates were highest in patients with diabetes (n=4; 4.0%), repeat procedures in diabetes (n=2; 2.0%) and MS (n=1; 2.5%), and stroke/TIA in MS (n=2; 5.0%).
Conclusions: These first results of IMPACT confirm the performance of a novel bioprosthesis with a good hemodynamic and safety profile. Nonetheless, patients with pre-existing comorbidities deserve special attention as they feature a greater morbidity and mortality.
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