title: Predictors of early and mid-term results in contemporary aortic valve replacement for aortic stenosis.
abstract: BACKGROUND
  The purpose of this study was to evaluate clinical risk factors and assess the impact of the Society of Thoracic Surgeons (STS) scores on outcomes after contemporary aortic valve replacement (AVR) for aortic stenosis (AS).
  
  
  METHODS
  We retrospectively analyzed the data from 209 consecutive patients with AS (mean 69 ± 9 years) who underwent AVR. The outcomes measured included operative mortality, postoperative complications, postoperative prolonged length of stay (PLOS), discharge to nonhome location, and mid-term mortality.
  
  
  RESULTS
  Operative mortality was 3.8%, and five-year survival was 88.6 ± 2.8%. Multivariable analysis revealed preoperative New York Heart Association (NYHA) class as a significant predictor of both operative mortality (p = 0.03; odds ratio [OR]: 8.5) and mid-term mortality (p = 0.02; OR: 10.5). NYHA class also emerged as an independent predictor for postoperative complications (p = 0.002; OR: 5.8) and PLOS (p = 0.01; OR: 2.5). Other preoperative independent predictors included dialysis for PLOS (p = 0.04; OR: 2.9), age (p = 0.03; OR: 1.1), and left ventricular ejection fraction (EF; p = 0.03; OR: 0.9) for nonhome discharge, and EF for mid-term mortality (p = 0.01; OR: 0.9). The mean STS-PROM (predicted risk of mortality) was 4.6% ± 6.1%, and thus, the observed-to-expected (O/E) ratio of operative mortality in our series was 0.82.
  
  
  CONCLUSIONS
  Advanced NYHA class, older age, dialysis, and lower EF are significant independent preoperative risk factors for early and mid-term results of AVR for AS. Consideration of these predictors should be used to identify high-risk patients requiring AVR for AS.
authors.affiliation: Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan. kuwakikj@yahoo.co.jp
authors.forename: Kenji
authors.initials: K
authors.lastname: Kuwaki
authors.forename: Atsushi
authors.initials: A
authors.lastname: Amano
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Inaba
authors.forename: Taira
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsumura
authors.forename: Shizuyuki
authors.initials: S
authors.lastname: Dohi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsushita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010360:Patient Transfer / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome