Risk Factors for Mortality and Morbidity of Surgical Aortic Valve Replacement for Aortic Stenosis　- Risk Model From a...

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Health Outcomes Research

Background:

• Transcatheter aortic valve replacement (TAVR) indications require careful consideration.
• Surgical aortic valve replacement (SAVR) outcomes, including mortality and morbidity, need better prediction.
• Aortic stenosis (AS) management necessitates understanding patient-specific risks.

Purpose of the Study:

• To determine adequate indications for transcatheter aortic valve replacement (TAVR).
• To analyze risk factors for mortality and morbidity in surgical aortic valve replacement (SAVR) for aortic stenosis (AS).
• To develop a predictive risk model for SAVR outcomes.

Main Methods:

• Analysis of 13,961 patients undergoing elective SAVR for AS from the Japan Adult Cardiovascular Surgery Database (JCVSD) (2008-2012).
• Identification of preoperative predictors for hospital mortality and morbidity (long hospital stay, compromised discharge status).
• Development and validation of a risk model using identified predictors (AUC for mortality: 0.732; AUC for morbidity: 0.694).

Main Results:

• Hospital mortality rate was 3.1%.
• Long hospital stay (≥90 days) occurred in 2.9% of patients.
• Moderately or severely compromised activity at discharge (mRS ≥4) affected 6.5% of patients.
• Eleven and 20 preoperative predictors for mortality and morbidity were identified, respectively.

Conclusions:

• A validated risk model for SAVR in AS patients was developed using the JCVSD.
• The model effectively identifies patients at high risk for both mortality and morbidity.
• This tool can aid in determining appropriate indications for SAVR versus TAVR.