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Incremental Risk of Annular Enlargement: A Multi-Institutional Cohort Study.
- Source :
-
The Annals of thoracic surgery [Ann Thorac Surg] 2019 Dec; Vol. 108 (6), pp. 1752-1759. Date of Electronic Publication: 2019 Jun 27. - Publication Year :
- 2019
-
Abstract
- Background: Annular enlargement (AE) is a critical technique to avoid patient-prosthesis mismatch and may help facilitate future valve-in-valve (ViV) transcatheter replacement. We hypothesized that the addition of annular enlargement would increase risk of morbidity and mortality and that the number of annular enlargement procedures is increasing to accommodate future ViV procedures.<br />Methods: Patients undergoing aortic valve replacement ± coronary surgery (2012 to 2017) were extracted from a regional Society of Thoracic Surgeons database. Patients were stratified by annular enlargement and era, pre-ViV (2012 to 2014) vs ViV (2015 to 2017) for univariate analysis. Risk-adjusted outcomes were assessed by hierarchical regression modeling adjusting for predicted risk of mortality.<br />Results: Of 6045 patients, the 300 (5.0%) who received an annular enlargement were younger and more commonly female. Patients receiving an annular enlargement had higher complication rates including operative mortality (4.7% vs 2.5%, P = .024). After risk adjustment, AE was independently associated with increased mortality (odds ratio, 2.06, P = .016) and major morbidity (odds ratio, 1.41, P = .042). The rate of enlargement increased from 3.9% pre-ViV to 6.3% ViV (P < .001). The use of ViV capable valves (bioprosthetic ≥23 mm) from 61% to 67% (P = .001), and more in AE patients (30% vs 11% non-AE). Alternatively, the rate of patient prosthesis mismatch declined from 23% to 16%.<br />Conclusions: Increasing utilization of AE coincides with a decline in patient prosthesis mismatch and may facilitate future ViV transcatheter aortic valve replacement. However, AE was independently associated with increased morbidity and mortality. High variability in AE volume may be increasing risk and deserves further investigation.<br /> (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Postoperative Complications epidemiology
Prosthesis Design
Prosthesis Failure
Retrospective Studies
Risk Factors
Survival Rate trends
United States epidemiology
Aortic Valve surgery
Aortic Valve Stenosis surgery
Heart Valve Prosthesis
Postoperative Complications etiology
Registries
Risk Assessment methods
Transcatheter Aortic Valve Replacement adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1552-6259
- Volume :
- 108
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The Annals of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 31254510
- Full Text :
- https://doi.org/10.1016/j.athoracsur.2019.04.118