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Published on 01.07.2021
Intraoperative details and the short-term outcome of a large consecutive series of patients operated on in a teaching tertiary institution.
Mean ± SD (CI) or n (%)total = 622 | |
Demographics | |
Age (years) | 59.5 ± 12.5 (16–85) |
Male | 423 (68%) |
Weight (kg) | 79.5 ± 16 (54.0–118) |
BMI (kg/m2) | 27.8 ± 4.3 (18–37.3) |
Preoperative characteristics | |
Nicotine | 218 (35%) |
Dyslipidaemia | 123 (19.7%) |
Hypertension | 181 (29.1%) |
EuroSCORE II | 3.7 (2–9) |
Logistic EuroSCORE II | 10.7 ± 9.5 (7.6–21.9) |
Left ventricular ejection fraction (%) | 58.8 ± 9.9 (27–71) |
Creatinine (mg/dl) | 89.8 ± 43.3 (77–182) |
Chronic kidney disease | 55 (8.8%) |
Prior neurologic event | 21 (3.3%) |
Coronary artery disease | 85 (13.6%) |
Chronic lung disease | 37 (5.9%) |
Connective tissue disease | 33 (Marfan = 28, Loeys-Dietz = 5) |
Functional class (dyspnoea) | |
– NYHA I | 288 (46%) |
– NYHA II | 226 (36.3%) |
– NYHA III | 93 (15%) |
– NYHA IV | 15 (2.7%) |
n (%)total = 622 | ||
Aortic valve disease | ||
None | 49 (7.8%) | |
Stenosis | 164 (26.5%) | |
– Mild | 57 (34.6%) | |
– Moderate | 68 (41.4%) | |
– Severe | 39 (23.8%) | |
Insufficiency | 409 (65.7%) | |
– Mild | 67 (16.4%) | |
– Moderate | 223 (54.5%) | |
– Severe | 119 (29.1%) | |
Mixed pathology | 195 (31.3%) | |
Aortic valve/root pathology(more than one characteristic per patient possible) | ||
Annulo-aortic ectasia | 448 (72%) | |
Bicuspid | 107 (17.3%) | |
Degenerative (other) | 60 (9.6%) | |
Connective tissue disease | 33 (5.3%) | |
Post-endocarditis | 7 (1.1%) | |
Size | Aortic root | Ascending aorta |
4.5–5 cm | 38 (6.1%) | 71 (11.4%) |
5–5.5 cm | 312 (50.1%) | 387 (62.2%) |
5.5–6 cm | 185 (29.7%) | 134 (21.5%) |
6 cm | 87 (14%) | 30 (4.8%) |
Mean ± SD (CI) or n (%)total = 622 | ||
Surgery | ||
Duration of operation (min) | 185 ± 48 (154–291) | |
Cardiopulmonary bypass time (min) | 110 ± 81 (90–253) | |
Cross-clamp time (min) | 86.5 ± 49 (51–143) | |
DHCA use | 195 (31.3%) | |
Duration of DHCA (min) | 16.2 ± 6.2 (8–46) | |
Type of valve prosthesis | ||
– Mechanical | 187 (31.1%) | |
– Biological | 435 (68.9%) | |
Mean prosthesis size (mm) | 25.8 ± 3.4 (21–29) | |
Mean graft vascular size (mm) | 28.6 ± 4.1 (24–32) | |
Type of procedure | ||
Isolated composite graft | 336 (44%) | |
Composite graft + hemi-arch | 195 (31.4%) | |
+ CABG | 46 | |
– + Mitral valve | 39 | |
– + PFO closure | 35 (8.3%) (alone or 31 combined with CABG or mitral valve) | |
– + Ablation atrial fibrillation | 6 (0.9%) | |
– + LAA occlusion | 57 (9.2%) | |
Postoperative stay | ||
ICU stay (days) | 1.7 ± 2.9 (1–13) | |
Hospital stay (days) | 8.9 ± 21.6 (7–29) |
Mean ± SD (CI) or n (%)total = 622 | |
Local complications | |
Bleeding | 22 (3.5%) |
Sternal infection | 28 (4.5%) |
– Deep | 11 (1.8%) |
– Superficial | 17 (2.7%) |
Cardiac complications | |
Myocardial infarction1 | 12 (1.9%) |
Definitive pacemaker | 29 (4.6%) |
Resuscitation | 5 (0.8%) |
Episode of atrial fibrillation | 152 (24.5%) |
Neurological complications | |
Diffuse cerebral damage | 7 (1.1%) |
Transient cerebral complication1 | 9 (1.4%) |
Renal complications | |
New post-operative renal insufficiency2 | 24 (3.9%) |
Temporary dialysis | 8 (1.3%) |
Pulmonary and other complications | |
ARDS | 7 (1.1%) |
Multiple organ failure | 3 (0.5%) |
In hospital mortality | 9 (1.4%) |
Univariate | |
Age | 0.621 |
Gender | 0.094 |
Hypertension | 0.148 |
Diabetes | 0.427 |
Hyperlipidaemia | 0.618 |
BMI 30 kg/m2 | 0.285 |
Coronary artery disease | 0.035* |
NYHA functional class III or IV | 0.002* |
Prior cerebrovascular disease | 0.405 |
Chronic kidney disease | 0.348 |
Chronic lung disease | 0.855 |
EuroScore II 3% | 0.07 |
Severe aortic regurgitation | 0.004* |
Left ventricular ejection fraction <0.3 | 0.001* |
CPB duration | 0.753 |
Aortic cross-clamp duration | 0.728 |
DHCA use | 0.328 |
Odds ratio | 95% confidence interval | p-value | |
Coronary artery bypass grafting | 4.25 | 1.63–11.34 | 0.002 |
NYHA functional class III or IV | 2.94 | 1.57–7.48 | 0.023 |
Aortic regurgitation grade IV | 6.35 | 1.84–17.82 | 0.018 |
LVEF <0.30 | 4.9 | 1.77–12.25 | 0.003 |
Isolated AVR (n = 1244)Mean ± SD (CI) or n (%) | |
Demographics | |
Age (years) | 67.3 ± 11.1 (24.6–78) |
Male | 748 (60.1%) |
Weight (kg) | 81.5 ± 21 (49–123) |
BMI (kg/m2) | 28.6 ± 5.3 (19–39.1) |
Preoperative characteristics | |
Nicotine | 510 (41%) |
Dyslipidaemia | 398 (32%) |
Hypertension | 485 (39%) |
EuroSCORE II | 2.9 (2–11) |
Logistic EuroSCORE II | 11.7 ± 8.5 (7.9–23.9) |
Left ventricular ejection fraction (%) | 59.4 ± 11.5 (23–75) |
Creatinine (mg/dl) | 85.4 ± 44.4 (68–210) |
Chronic kidney disease | 93 (7.5%) |
Prior neurological event | 31 (2.5%) |
Coronary artery disease | 236 (19.1%) |
Chronic lung disease | 100 (8%) |
Connective tissue disease | – |
Functional class (dyspnoea) | |
– NYHA 1 | 273 (22%) |
– NYHA 2 | 523 (41.2%) |
– NYHA 3 | 390 (31.4%) |
– NYHA 4 | 58 (5.4%) |
Surgery | |
Duration of operation (min) | 158 ± 42 (105–210) |
CPB time (min) | 70.6 ± 25.6 (43.0–110) |
Cross-clamp time (min) | 50.3 ± 21.2 (29–92) |
DHCA use | 65 (5.3%) |
Duration of DHCA (min) | 14.2 ± 8.2 (9–31) |
Type of valve prosthesis | |
Mechanical | 187 (13.3%) |
Biological stented | 345 (73.5%) |
Biological stentless | 90 (4.1%) |
Mean prosthesis size (mm) | 23.3 ± 2.2 (23.1–23.4) |
Type of procedure | |
Isolated aortic valve replacement | 919 (73.8%) |
+ CABG* | 211 (17%) |
+ Mitral valve* | 81 (6.5%) |
+ Supracoronary graft* | 109 (8.7%) |
+ PFO closure* | 45 (3.6%) |
+ Ablation atrial fibrillation* | 70 (5.6%) |
+ LAA occlusion* | 69 (5.5%) |
Postoperative stay | |
ICU stay (days) | 1.5 ± 2.4 (1–7) |
Hospital stay (days) | 10.1 ± 11.6 (6–24) |
Local complications | |
Bleeding | 30 (2.4%) |
Cardiac complications | |
Myocardial infarction1 | 17 (1.4%) |
Definitive pacemaker | 75 (6.0%) |
Resuscitation | 7 (0.6%) |
Episode of atrial fibrillation | 367 (29.5%) |
Neurological complications | |
Diffuse cerebral damage | 26 (2.1%) |
Transient cerebral complication | 14 (1.1%) |
Renal complications | |
Temporary dialysis | 15 (1.2%) |
Pulmonary and other complications | |
ARDS | 16 (1.3%) |
Multiple organ failure | 5 (0.4%) |
In-hospital mortality | 0 (0.8%) |
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