Vincent Chan1,2, Fraser Rubens1, Munir Boodhwani1, Thierry Mesana1, Marc Ruel1,2
1Division of Cardiac Surgery, 2Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
Background and aim of the study: Although one of the goals of surgical aortic valve replacement (AVR) is to alleviate congestive heart failure (CHF), the latter often occurs after AVR. Surprisingly, the incidence of CHF after AVR remains unclear, as outcomes are reported according to valve-related complications, each of which may result in CHF. The study aim was to: (i) validate a previously described model predicting persistent or recurrent CHF after
AVR in a contemporary cohort; and (ii) apply the model to predict late outcomes following AVR with the Trifecta valve.
Methods: A previously described statistical model was validated in a cohort of 1,014 patients who received the St. Jude Trifecta prosthesis between 2007 and 2009. A sensitivity analysis was performed to determine the influence of risk factors associated with late CHF. Model prediction was verified with a Monte Carlo simulation
employing 10,000 iterations.
Results: The model accurately predicted late CHF events in a contemporary cohort. Sensitivity analysis identified mean transprosthesis gradient (MTG), body surface area (BSA), and preoperative NYHA class as important CHF risk factors. Based on the model, a 5 mmHg decrease in MTG was associated with 2.5% and 10.4% reductions in late CHF at five and 15 years, respectively. A 10% decrease in mean BSA and preoperative NYHA class IV symptoms were associated with a 1% decrease and a 5% increase in CHF events at 15 years after AVR.
Conclusion: The authors’ previously described model predicting persistent or recurrent CHF after AVR was validated in a contemporary cohort. This model may be applied to predict outcomes in patients who receive modern prostheses, without long-term follow up.
The Journal of Heart Valve Disease 2014;23:665-670
|Determinants of Persistent or Recurrent Congestive Heart Failure after Contemporary Surgical Aortic Valve Replacement|
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