Do postoperative hemodynamic parameters add prognostic value for mortality after surgical aortic valve replacement?Central MessagePerspective
Bart J.J. Velders, MD,
Michiel D. Vriesendorp, MD, PhD,
Federico M. Asch, MD,
Francois Dagenais, MD,
Rüdiger Lange, MD,
Michael J. Reardon, MD,
Vivek Rao, MD,
Joseph F. Sabik, III, MD,
Rolf H.H. Groenwold, MD, PhD,
Robert J.M. Klautz, MD, PhD
Affiliations
Bart J.J. Velders, MD
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands; Address for reprints: Bart J. J. Velders, MD, Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, Zuid-Holland 2333 ZA, The Netherlands.
Michiel D. Vriesendorp, MD, PhD
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
Federico M. Asch, MD
Cardiovascular Core Laboratories, MedStar Health Research Institute, Washington, DC
Francois Dagenais, MD
Division of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Quebec, Canada
Rüdiger Lange, MD
Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
Michael J. Reardon, MD
Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex
Vivek Rao, MD
Department of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada
Joseph F. Sabik, III, MD
Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio
Rolf H.H. Groenwold, MD, PhD
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
Robert J.M. Klautz, MD, PhD
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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.
