Do postoperative hemodynamic parameters add prognostic value for mortality after surgical aortic valve replacement?

Background: Although various hemodynamic parameters to assess prosthetic performance are available, prosthesis-patient mismatch (PPM) is defined exclusively by effective orifice area (EOA) index thresholds. Adjusting for the Society of Thoracic Surgeons predicted risk of mortality (STS PROM), we aimed to explore the added value of postoperative hemodynamic parameters for the prediction of all-cause mortality at 5 years after aortic valve replacement.
Methods: Data were obtained from the Pericardial Surgical Aortic Valve Replacement (PERIGON) Pivotal Trial, a multicenter prospective cohort study examining the performance of the Avalus bioprosthesis. Candidate predictors were assessed at the first follow-up visit; patients who had no echocardiography data, withdrew consent, or died before this visit were excluded. Candidate predictors included peak jet velocity, mean pressure gradient, EOA, predicted and measured EOA index, Doppler velocity index, indexed internal prosthesis orifice area, and categories for PPM. The performance of Cox models was investigated using the c-statistic and net reclassification improvement (NRI), among other tools.
Results: A total of 1118 patients received the study valve, of whom 1022 were eligible for the present analysis. In univariable analysis, STS PROM was the sole significant predictor of all-cause mortality (hazard ratio, 1.40; 95% confidence interval, 1.26-1.55). When extending the STS PROM with single hemodynamic parameters, neither the c-statistics nor the NRIs demonstrated added prognostic value compared to a model with STS PROM alone. Similar findings were observed when multiple hemodynamic parameters were added.
Conclusions: The STS PROM was found to be the main predictor of patient prognosis. The additional prognostic value of postoperative hemodynamic parameters for the prediction of all-cause mortality was limited.
Competing Interests: Dr Velders reported institutional research grant and speaker fees paid to his department by 10.13039/100004374Medtronic. Dr Vriesendorp reported institutional research support and reimbursement of travel expenses from 10.13039/100004374Medtronic. Dr Asch reported institutional grants or research contracts from Medtronic, Abbott, Edwards Lifesciences, Boston Scientific, 10.13039/501100005035Biotronik, Corcym, and HLT Medical. Dr Dagenais reported serving as a lecturer, consultant, and proctor for Cook Medical; a proctor and lecturer for Medtronic; and a lecturer for Edwards Lifesciences. Dr Lange reported serving as a consultant for Medtronic, being a stockholder in and receiving royalties from Medtronic, and consulting for HighLife Medical. Dr Reardon reported consulting for Medtronic, Abbott Medical, Boston Scientific, Gore Medical, and Transverse Medical, with fees paid to his department. Dr Rao reported consulting for Medtronic, Gore, and Abbott and serving on an advisory board for Medtronic. Dr Sabik was the North American Principal Investigator for the PERIGON Pivotal Trial, Medtronic. Dr Groenwold reported no conflicts of interest. Dr Klautz was European Principal Investigator of the PERIGON Pivotal Trial and reported research support and consultation fees from 10.13039/100004374Medtronic. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.
(© 2023 The Author(s).)