Current determinants of operative mortality in 1400 patients requiring aortic valve replacement.
BACKGROUND
Determinants of operative mortality after aortic valve replacement vary with a changing patient population due to advances in operative management and increasing life expectancy. In order to predict current groups of high risk patients, a statistically valid large study population base recruited over a short period of time is required.


METHODS
Between January 1996 and June 2001, 1408 aortic valves were replaced in 1400 patients (572 of them with simultaneous coronary artery bypass grafting). The data were analyzed by multivariate logistic regression to evaluate the operative risk. Mean age of the study population was 68 +/- 11 years (range 19 to 90 years old, 44% female).


RESULTS
Overall operative mortality (within 30 days) was 3.8%. Independent predictive factors for operative mortality were previous bypass surgery, emergency operation, simultaneous mitral valve replacement, renal dysfunction, more than 80 years old, simultaneous bypass surgery in female patients with a body mass index greater than 29 kg/m(2), and height smaller than 1.57 m for patients more than 71 years old. Simultaneous coronary artery bypass grafting in general (p = 0.6), previous aortic valve replacement (p = 0.59), and implantation of stented bioprostheses (p = 0.39) or stentless bioprostheses (p = 0.7) were not identified as independent risk factors.


CONCLUSIONS
Certain groups of patients with a high operative risk were identified: patients more than 80 years old, women with a body mass index greater 29 kg/m(2) undergoing simultaneous coronary artery bypass surgery, and "small" patients more than 71 years old.
Florath
Ines
I
Department of Cardiothoracic Surgery, Heart Institute Lahr/Baden, Lahr, Germany.
Rosendahl
Ulrich P
UP
Mortasawi
Amir
A
Bauer
Stefan F
SF
Dalladaku
Fatmir
F
Ennker
Ina C
IC
Ennker
Juergen C
JC
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality*; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D018570:Risk Assessment; D017678:Sex Distribution