Independent predictors for early and long-term mortality after heart valve surgery.
OBJECTIVE
Patients with heart valve surgery may have a periprocedural mortality extending up to one year after surgery. The study aim was to determine independent predictors for in-hospital and long-term mortality after heart valve surgery.


METHODS
A total of 1,376 consecutive patients who underwent isolated or combined heart valve surgery at a single institution was studied. Multivariate logistic regression analysis was used to determine independent predictors for in-hospital mortality. Long-term survival data (mean follow up 5.6 years) were obtained from the National Death Index. Multivariate Cox regression analysis was used to determine independent predictors for long-term mortality. All available preoperative, intraoperative and postoperative risk factors were included in these analyses.


RESULTS
The mean EuroSCORE was 6.2 +/- 3.7. There were 86 (6.3%) in-hospital and 550 (40.0%) late deaths. Eleven independent predictors were determined for in-hospital mortality, and 13 for long-term mortality. There were six common independent predictors (preoperative dialysis, total bypass time, intraoperative stroke, postoperative sepsis and/or endocarditis, renal and respiratory failure). Unique independent predictors for in-hospital mortality included intra-aortic balloon pump, preoperative endocarditis, intravenous use of nitroglycerine, bleeding requiring reoperation and gastrointestinal complications. The model for in-hospital mortality showed acceptable calibration (Lemeshow-Hosmer, p = 0.629) and excellent discriminatory ability (C statistic 0.88). Unique independent predictors for long-term mortality included age, ejection fraction, stroke prior to surgery, hemodynamic instability, chronic obstructive pulmonary disease and deep sternal wound infection.


CONCLUSIONS
Independent predictors were determined for early and long-term mortality after heart valve surgery. The prevention of postoperative complications may be a key element for increased early and long-term survival in these patients.
Toumpoulis
Ioannis K
IK
Columbia University College of Physicians and Surgeons, St. Luke's-Roosevelt Hospital Center, Department of Cardiothoracic Surgery, New York, USA. toumpoul@otenet.gr
Chamogeorgakis
Themistocles P
TP
Angouras
Dimitrios C
DC
Swistel
Daniel G
DG
Anagnostopoulos
Constantine E
CE
Rokkas
Chris K
CK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009518:New York; D011183:Postoperative Complications / Q000401:mortality*; D012307:Risk Factors