Risk factors for congestive heart failure after aortic valve replacement with a Carpentier-Edwards pericardial prosthesis in the elderly
Mistiaen, W.P.; Van Cauwelaert, P.; Muylaert, P.; Wuyts, F.; Bortier, H.
Journal of Heart Valve Disease 14(6): 774-779
2005
ISSN/ISBN: 0966-8519 PMID: 16359058 Document Number: 587301
Congestive heart failure (CHF) after aortic valve replacement (AVR) is an important cause of morbidity. The study aim was to identify preoperative risk factors for CHF. A total of 500 consecutive patients (271 males, 229 females; median age 73 years; range: 71-77 years) was investigated retrospectively. The AVR was performed using a Carpentier-Edwards pericardial valve, and a total of 348 additional procedures (313 coronary artery bypass grafts; CABG) was carried out. The outcome studied was CHF, during both hospital stay and long-term follow up. Univariate and multivariate statistical analyses were used to investigate 15 risk factors. During the hospital stay, 13 patients developed CHF, with four fatalities. Significant risk factors for CHF included urgent operation (p = 0.031), preoperative atrial fibrillation (AF) (p = 0.031) and NYHA functional class IV (p = 0.05). A logistic regression analysis revealed need for urgent operation (p = 0.034) as the sole factor. During long-term follow up, 43 patients developed CHF, with seven fatalities. Univariate analysis identified seven risk factors with significant effect: valve size <19 mm (p = 0.004), preoperative conduction defects (p = 0.007), chronic postoperative AF (p = 0.013), cross-clamp time >75 min (p = 0.032), NYHA class IV (p = 0.041), coronary artery disease (CAD) (p = 0.043) and additional CABG (p = 0.050). Multivariate analysis identified three risk factors: preoperative conduction defects (p = 0.004), postoperative AF (p = 0.005) and CAD (p = 0.037) Morbidity due to CHF after AVR could be minimized with correct treatment of AF and of conduction defects. Patient age, valve size, cross-clamp time and preoperative severity or symptoms were not independent risk factors. Moreover, small native aortic valve rings should not necessarily be enlarged, the cross-clamp time should be kept to a minimum, and surgery should not be delayed when symptoms have developed.