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The Journal of Thoracic and Cardiovascular Surgery, Vol 89, 400-413, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
WC Scott, DC Miller, A Haverich, K Dawkins, RS Mitchell, SW Jamieson, PE Oyer, EB Stinson, JC Baldwin and NE Shumway
The influence of 35 preoperative and intraoperative characteristics on
operative mortality risk after 1,479 isolated aortic valve replacement
procedures (1967 to 1981) was investigated utilizing univariate and
multivariate logistic regression analyses. Mean age at operation was 58 +/-
13 years; 72% of patients were men. Physiology was classified as aortic
stenosis (58%), regurgitation (30%), or both (9%). The overall operative
mortality rate was 7% +/- 1%, but there were substantial differences in
operative mortality rates among physiological subgroups (aortic
regurgitation, 10% +/- 2%; aortic stenosis, 6% +/- 1%;
stenosis/regurgitation, 5% +/- 2%). Independent determinants of operative
mortality rate in the entire group were advanced New York Heart Association
functional class, renal dysfunction, physiological subgroup, atrial
fibrillation, and older age. In the aortic regurgitation subgroup,
functional class, atrial fibrillation, and operative year were independent
predictors. In the aortic stenosis subgroup, the significant determinants
were functional class, renal dysfunction, age, prosthetic valve
dysfunction, and absence of angina. Concomitant coronary bypass grafting,
previous operation, endocarditis, and ascending aortic replacement had no
independent predictive effect on operative mortality rate. Thus, the early
results of aortic valve replacement can be related to several specific
variables describing the functional and physiological status of the
patient. Operative mortality rate is not independently related to previous
operation or concomitant operative procedures. Specific differences in risk
factors exist among the various physiological subgroups, probably
reflecting the pathophysiology of the different hemodynamic lesions. This
information should provide for a more rational approach to aortic valve
replacement, at least in terms of early risk/benefit deliberations.
ARTICLES
Determinants of operative mortality for patients undergoing aortic valve replacement. Discriminant analysis of 1,479 operations
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