Do postoperative hemodynamic parameters add prognostic value for mortality after surgical aortic valve replacement?

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Clinical Outcomes Research

Background:

• Prosthesis-patient mismatch (PPM) is currently defined by effective orifice area (EOA) index thresholds.
• The prognostic value of postoperative hemodynamic parameters beyond the Society of Thoracic Surgeons predicted risk of mortality (STS PROM) after aortic valve replacement requires further investigation.

Purpose of the Study:

• To evaluate the added prognostic value of postoperative hemodynamic parameters for predicting 5-year all-cause mortality after aortic valve replacement.
• To determine if hemodynamic parameters offer incremental predictive power beyond STS PROM.

Main Methods:

• Analysis of data from the Pericardial Surgical Aortic Valve Replacement (PERIGON) Pivotal Trial, a prospective multicenter cohort study.
• Inclusion of 1022 patients who underwent aortic valve replacement with the Avalus bioprosthesis.
• Assessment of candidate hemodynamic predictors (e.g., peak jet velocity, mean pressure gradient, EOA index) and STS PROM.
• Utilized Cox models, c-statistics, and net reclassification improvement (NRI) to evaluate model performance.

Main Results:

• The Society of Thoracic Surgeons predicted risk of mortality (STS PROM) was the only significant univariable predictor of all-cause mortality.
• Adding single or multiple postoperative hemodynamic parameters to STS PROM did not significantly improve the predictive accuracy (c-statistics) or reclassification of mortality risk (NRI).

Conclusions:

• The Society of Thoracic Surgeons predicted risk of mortality (STS PROM) is the primary determinant of patient prognosis after aortic valve replacement.
• Postoperative hemodynamic parameters provide limited additional prognostic value for predicting all-cause mortality in this patient cohort.