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Aim: Postoperative renal dysfunction after aortic valve replacement is a serious complication. To minimize its occurrence, risk factors have to be identified, and if possible eliminated., Methods: Of 1000 consecutive patients, who underwent AVR, a file study was performed chi(2)nd logistic regression analysis were performed to study the effect of 24 preoperative, 7 peroperative and 7 postoperative factors on the occurrence of 30-day postoperative worsening of renal function., Results: Fifty-three patients had a 30-day postoperative decrease of renal function. Nine of these patients died, which is significantly more than the mortality without this complication (P<0.0001). In those nine patients, another complication (postoperative heart failure, thromboembolism or respiratory failure) was present. Thirteen factors were significant in an univariate analysis: preoperative renal dysfunction (P<0.001), age>80 (P<0.001), atrial fibrillation (P<0.001) , preoperative pulmonary edema (P=0.001), conduction defect (P=0.002), diabetes (P=0.006), myocardial infarction (P=0.006), postoperative heart failure (P=0.007), cross clamp time >75 min (P=0.015), previous coronary artery bypass grafting (CABG) (P=0.018), concomitant CABG (P=0.031), ejection fraction <50% (P=0.033) and CVA (P=0.035). Four factors were identified as independent predictors in a multivariate analysis: renal dysfunction (P<0.001, Odds ratio [OR] 5.5; 95% confidence interval [CI] 2.9-10.4), preoperative atrial fibrillation (P=0.010, OR=2.3, 95% CI=1.2-4.2), age>80 (P=0.014, OR=2.2, 95% CI=1.2-4.1) and myocardial infarction (P=0.022, OR=2.2, 95% CI=1.1-4.4)., Conclusions: Few factors are liable for therapeutic intervention, especially in elderly and patients with comorbidity. In patients with risk factors, shortening of cross clamping time or installation of minimal extracorporeal circulation might be beneficial.

Question: What factors predict postoperative pulmonary and pleural complications following aortic valve replacement?, Design: Retrospective study., Participants: One thousand consecutive patients who underwent aortic valve replacement with a pericardial valve between 1986 and 2006. Of these, 610 underwent also coronary artery surgery., Outcome Measures: Thirty putative predictors were investigated. Postoperative pulmonary complications (defined as respiratory failure, pneumonia, atelectasis) and postoperative pleural complications (defined as pleural effusion, pneumothorax, haemothorax, empyema) within 30 days of surgery were identified., Results: 58 (6%) patients developed pulmonary complications and 45 (5%) developed pleural complications. None of the pleural and only 3 of the pulmonary complications were fatal if they occurred alone. Postoperative heart failure (OR 4.7, 95% CI 1.8 to 11.9), previous pacemaker implant (OR 4.4, 95% CI 1.8 to 11.2) and chronic obstructive pulmonary disease (OR 1.7, 95% CI 1.0 to 3.1) independently predicted postoperative pulmonary complications. Postoperative bleeding (OR 7.4, 95% CI 1.8 to 29.9), carotid artery disease (OR 2.8, 95% CI 1.4 to 5.5), previous coronary artery surgery (OR 2.7, 95% CI 1.1 to 6.4), chronic obstructive pulmonary disease (OR 1.9, 95% CI 1.0 to 3.8) and cardiac conduction defect (OR 1.9, 95% CI 1.0 to 3.7) independently predicted postoperative pleural complications., Conclusions: Postoperative pulmonary and pleural complications were rare. A history of cardiac and/or pulmonary problems are risk factors for pulmonary complications after aortic valve replacement. Further study is needed to reveal if preventive physiotherapeutic intervention in these patients is effective.

Background and Aim of the Study: Over the past 20 years, both the typical age and co-morbidity of patients referred for aortic valve replacement (AVR) have increased. In order to assess the effect of these changes on hospital complications, an evaluation was conducted of patient characteristics within this time period., Methods: This retrospective study included 1,000 consecutive patients who underwent AVR with a pericardial valve. Concomitant coronary artery bypass grafting (CABG) was performed in 610 cases. Among 25 preoperative and five perioperative factors, and eight hospital complications, the changes in incidence that occurred during the periods 1986-1991, 1992-1996, 1997-2001, and 2002-2006, were investigated. Predictive factors for non-cardiac hospital complications required further exploration, as these were the only complications to increase significantly with time; however, this type of complication is less lethal., Results: Significant increases were identified in age, and in the incidence of non-cardiac co-morbidity, previous CABG and preoperative congestive heart failure (p mostly <0.0001). Among hospital complications, only non-cardiac problems showed a significant increase. The independent predictors included previous CABG (p = 0.004), concomitant CABG (p = 0.006), renal impairment (p = 0.008), conduction defects (p = 0.010), previous pacemaker implantation (p = 0.014), chronic obstructive lung disease (p = 0.015), and concomitant carotid artery surgery (p = 0.032)., Conclusion: During the past 20 years, patients referred for AVR have become older and have more co-morbidity. However, the incidence only of non-cardiac hospital complications was increased. Previous and concomitant surgery, as well as non-cardiac co-morbidity, are important predictors that must be taken into account at referral, but should not contraindicate AVR.

Objectives: Thromboembolic events after aortic valve replacement with a bioprosthesis were the most frequently occurring complications in elderly patients. Whether this was valve related or dependent on other factors needed further exploration., Methods: Five hundred patients with a median age of 73 years were followed retrospectively after aortic valve replacement with a pericardial prosthesis for occurrence of thromboembolism. Of these, 348 also underwent coronary artery bypass grafting. Twenty-five factors were investigated for their potential effect by using univariate and multivariate analysis., Results: Univariate analysis revealed 6 significant factors: preoperative endocarditis (P =.0001), preoperative cerebrovascular accident (P =.002), use of postoperative warfarin sodium (Coumadin, DuPont Merck; P =.006), arterial hypertension (P =.023), size of valve prosthesis of 27 mm or larger (P =.023), and hospital thromboembolism (P =.040). There was a trend toward increased fatal thromboembolism in patients without medication. With a multivariate analysis, 4 factors remained significant: preoperative cerebrovascular accident (risk ratio, 4.8; P =.0016), warfarin sodium (risk ratio, 3.0; P =.0028), preoperative endocarditis (risk ratio, 5.6; P =.006), and hospital thromboembolism (risk ratio, 6.1; P =.016). Hypertension had a borderline effect. Age, sex, diabetes, 4 coronary artery factors, 3 other valvular factors, atrial fibrillation, and carotid artery disease had no significant effect., Conclusions: Some emboli seemed triggered by the valve prosthesis. A proper anticoagulant protocol but also a treatment of hypertension is important in the prevention of thromboembolism after aortic valve replacement with a bioprosthesis. We did not find a significant role of atrial fibrillation and carotid artery disease.

Background and Aim of the Study: The effect of concurrent disease and cardiac comorbidity on survival after bioprosthetic valve replacement in elderly patients was assessed retrospectively. Risk factors were categorized as general, non-cardiac (age, diabetes, previously treated carcinoma) and cardiac (LVEF, three-vessel disease, previous CABG or valve replacement, and endocarditis)., Methods: A total of 400 elderly patients (median age 73 years; range: 71-76 years) was studied. Medical history included diabetes, previous CABG or aortic valve replacement (AVR), endocarditis and treatment of previous carcinoma. A left ventricular ejection fraction (LVEF) of <0.66 and presence of three-vessel disease were also investigated. Hospital deaths (and cause) were recorded; survival or date and cause of death after discharge were obtained by questionnaire. Kaplan-Meier univariate and Cox proportional hazards multivariate regression analyses were carried out., Results: Mortality during follow up was 28.3%; hospital mortality was 3.8%. Univariate analysis showed five factors significantly to affect survival: LVEF, history of endocarditis, carcinoma, age and three-vessel disease. Fifteen of 38 patients with history of carcinoma died, 10 due to a malignancy. Of 76 patients with three-vessel disease, 26 died. A history of diabetes and previous CABG did not influence survival significantly. Four of eight patients with preoperative endocarditis died, all in hospital. Six of 11 patients died after redo-AVR, none before 36 months follow up. By Cox regression analysis, LVEF and histories of carcinoma and endocarditis remained significant., Conclusion: AVR should be performed before ventricular deterioration occurs. Previous CABG is not a contraindication for AVR. Endocarditis impaired survival. Long-term mortality after redo-AVR in this population was relatively high, but acceptable. AVR should also be performed in elderly patients with aortic valve disease. Since prognosis of symptomatic aortic valve disease is poor in the short term, AVR is indicated in patients treated for carcinoma.