Impact of explanted valve type on aortic valve reoperations: nationwide UK experience

• Published in: European journal of cardio-thoracic surgery Vol. 65; no. 2
• Main Authors: Narayan, Pradeep, Dong, Tim, Dimagli, Arnaldo, Fudulu, Daniel P, Chan, Jeremy, Sinha, Shubhra, Angelini, Gianni D
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 01.02.2024
• Subjects: Aortic Valve - surgery; Bioprosthesis - adverse effects; Conventional Valve Operations; Endocarditis - surgery; Heart Valve Prosthesis - adverse effects; Heart Valve Prosthesis Implantation - adverse effects; Humans; Reoperation; Retrospective Studies; Stroke Volume; Treatment Outcome; United Kingdom - epidemiology; Ventricular Function, Left; United Kingdom; Reoperation; In-hospital mortality; Mechanical valve; Bioprosthetic valve; UK; Aortic valve surgery
• DOI: 10.1093/ejcts/ezae031
• ISSN: 1873-734X; 1010-7940

Abstract OBJECTIVES This nationwide retrospective cohort study assessed the impact of the explanted valve type on reoperative outcomes in aortic valve surgery within the UK over a 23-year period. METHODS Data were sourced from the National Institute for Cardiovascular Outcomes Research (NICOR) database. All patients undergoing first-time isolated reoperative aortic valve replacement between 1996 and 2019 in the UK were included. Concomitant procedures, homograft implantation or aortic root enlargement were excluded. Propensity score matching was utilized to compare outcomes and risk factors for in-hospital mortality was evaluated through multivariable logistic regression. Final model selection was conducted using Akaike Information Criterion through bootstrapping. The primary end point was in-hospital mortality, and secondary end points included postoperative morbidities. RESULTS Out of 2371 patients, 24.9% had mechanical and 75% had bioprosthetic valves implanted during the primary procedure. Propensity matched groups of 324 patients each, were compared. In-hospital mortality for mechanical and bioprosthetic valve explants was 7.1% and 5.9%, respectively (P = 0.632). On multivariable logistic regression analysis, valve type was not a risk factor for mortality [odds ratio (OR) 0.62, 95% confidence interval (CI) 0.37–1.05; P = 0.1]. Age (OR 1.03, 95% CI 1.01–1.05; P < 0.05), left ventricular ejection fraction (OR 1.62, 95% CI 1.08–2.42; P < 0.05), creatinine ≥ 200 mg/dl (OR 2.21, 95% CI 1.17–4.04; P < 0.05) and endocarditis (OR 2.66, 95% CI 1.71–4.14; P < 0.05) emerged as risk factors for mortality. CONCLUSIONS The type of valve initially implanted (mechanical or bioprosthetic) did not determine mortality. Instead, age, left ventricular ejection fraction, renal impairment and endocarditis were significant risk factors for in-hospital mortality. Reoperations on prosthetic aortic valves may be necessary due to several reasons.