Tomislav Mihaljevic, MD, Edward R

Slides:

Advertisements

Similar presentations

Moderate Tricuspid Regurgitation With Left-Sided Degenerative Heart Valve Disease: To Repair or Not to Repair? Jose L. Navia, MD, Nicolas A. Brozzi,

Advertisements

Spinal cord protective strategies during descending and thoracoabdominal aortic aneurysm repair in the modern era: The role of intrathecal papaverine

Residual patient, anatomic, and surgical obstacles in treating active left-sided infective endocarditis Syed T. Hussain, MD, Nabin K. Shrestha, MD, Steven.

Robert J. Dabal, MD, James K

Generating New Knowledge in Cardiac Interventions

Surgical management of secondary tricuspid valve regurgitation: Annulus, commissure, or leaflet procedure? Jose L. Navia, MD, Edward R. Nowicki, MD,

Moderate Tricuspid Regurgitation With Left-Sided Degenerative Heart Valve Disease: To Repair or Not to Repair? Jose L. Navia, MD, Nicolas A. Brozzi,

Prognosis of patients removed from a transplant waiting list for medical improvement: Implications for organ allocation and transplantation for status.

Advising complex patients who require complex heart operations

Should lung transplantation be performed for patients on mechanical respiratory support? The US experience David P. Mason, MD, Lucy Thuita, MS, Edward.

Lars G. Svensson, MD, PhD, Lillian H. Batizy, MS, Eugene H

Morbidity of Bleeding After Cardiac Surgery: Is It Blood Transfusion, Reoperation for Bleeding, or Both? Alessandro Vivacqua, MD, Colleen G. Koch, MD,

Effect of changes in postoperative spirometry on survival after lung transplantation David P. Mason, MD, Jeevanantham Rajeswaran, MSc, Liang Li, PhD,

Current Effectiveness and Risks of Isolated Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy Nicholas G. Smedira, MD, Bruce W. Lytle, MD,

Endovascular versus open elephant trunk completion for extensive aortic disease Eric E. Roselli, MD, Sreekumar Subramanian, MD, Zhiyuan Sun, BS, Jahanzaib.

Surgical treatment of pseudoaneurysm of the thoracic aorta

Association between indices of prosthesis internal orifice size and operative mortality after isolated aortic valve replacement Charles R. Bridges, MD,

Factors influencing early and late outcome of the arterial switch operation for transposition of the great arteries Gil Wernovsky, MD* (by invitation),

Duration of inotropic support after left ventricular assist device implantation: Risk factors and impact on outcome Soren Schenk, MD, Patrick M. McCarthy,

Reoperation After Mitral Valve Repair for Degenerative Disease

Bruce W. Lytle, MD, Eugene H. Blackstone, MD, Joseph F

Surgical revascularization techniques that minimize surgical risk and maximize late survival after coronary artery bypass grafting in patients with diabetes.

Clostridium difficile infection after cardiac surgery: Prevalence, morbidity, mortality, and resource utilization Suresh Keshavamurthy, MBBS, MS, Colleen.

Coronary artery bypass grafting in diabetics: A growing health care cost crisis Sajjad Raza, MD, Joseph F. Sabik, MD, Ponnuthurai Ainkaran, MS, Eugene.

Surgical Repair of Posterior Mitral Valve Prolapse: Implications for Guidelines and Percutaneous Repair Douglas R. Johnston, MD, A. Marc Gillinov, MD,

Effects of right ventricular morphology and function on outcomes of patients with degenerative mitral valve disease Ying Ye, BS, Ravi Desai, MD, Lina.

Prosthesis size and long-term survival after aortic valve replacement

Appropriate patient selection or health care rationing

Albert S. Y. Chang, MD, Nicholas G. Smedira, MD, Catherine L

Spinal cord protective strategies during descending and thoracoabdominal aortic aneurysm repair in the modern era: The role of intrathecal papaverine

Does a similar procedure result in similar survival for women and men undergoing isolated coronary artery bypass grafting? Tamer Attia, MD, MSc, Colleen.

Aortic valve replacement: Is valve size important?

Simple versus complex degenerative mitral valve disease

A. Marc Gillinov, MD, Eugene H. Blackstone, MD, Edward R

Capturing echocardiographic allograft valve function over time after allograft aortic valve or root replacement M. Mostafa Mokhles, PhD, MSc, Jeevanantham.

Understanding right ventricular dysfunction and functional tricuspid regurgitation accompanying mitral valve disease Lina Maria Vargas Abello, MD, Allan.

Gabriel Loor, MD, Liang Li, PhD, Joseph F

Atrial fibrillation complicating lung cancer resection

Long-Term Durability of Bicuspid Aortic Valve Repair

Reduced survival in women after valve surgery for aortic regurgitationEffect of aortic enlargement and late aortic rupture Monica L. McDonald, MDa, Nicholas.

del Nido versus Buckberg cardioplegia in adult isolated valve surgery

Outcomes of less invasive J-incision approach to aortic valve surgery

Nicholas G. Smedira, MD, Katherine J. Hoercher, RN, Dustin Y

Eugene H. Blackstone, MDa,b, Bruce W. Lytle, MDb

Distal aortic interventions after repair of ascending dissection: The argument for a more aggressive approach Eric E. Roselli, MD, Gabriel Loor, MD,

Edward R. Nowicki, MD, MS, Gösta B. Pettersson, MD, PhD, Nicholas G

Sudish C. Murthy, MD, PhD, Edward R. Nowicki, MD, MS, David P

Two internal thoracic artery grafts are better than one

Are allografts the biologic valve of choice for aortic valve replacement in nonelderly patients? Comparison of explantation for structural valve deterioration.

Effect of the prosthesis–patient mismatch on long-term clinical outcomes after isolated aortic valve replacement for aortic stenosis: A prospective observational.

Long-term effectiveness of operations for ascending aortic dissections

Decision support in surgical management of ischemic cardiomyopathy

Lars G. Svensson, MD, PhD, Fernando A. Atik, MD, Delos M

Mohammed A Quader, MD, Patrick M McCarthy, MD, A

Colleen G. Koch, MD, MS, MBA, Edward R

Is repair preferable to replacement for ischemic mitral regurgitation?

Ventilatory dependency after cardiovascular surgery

Joseph F. Sabik, MD, Gabriel Olivares, MD, Sajjad Raza, MD, Bruce W

Douglas R. Johnston, MD, Edward G

Turki B. Albacker, MD, MSc, Eugene H. Blackstone, MD, Sarah J

Age and valve size effect on the long-term durability of the Carpentier-Edwards aortic pericardial bioprosthesis Michael K Banbury, MD, Delos M Cosgrove,

Mitral valve repair with aortic valve replacement is superior to double valve replacement A.Marc Gillinov, MD, Eugene H Blackstone, MD, Delos M Cosgrove,

Arvind K. Agnihotri, MD (by invitation), David C

Pulmonary hypertension is associated with worse early and late outcomes after aortic valve replacement: Implications for transcatheter aortic valve replacement

A. Marc Gillinov, MD, Jon Sirak, MD, Eugene H

Prosthesis–patient mismatch after aortic valve replacement predominantly affects patients with preexisting left ventricular dysfunction: Effect on survival,

Hemodynamic stability during 17 years of the carpentier-edwards aortic pericardial bioprosthesis Michael K Banbury, MD, Delos M Cosgrove, MD, James D.

Identifying risk factors: Challenges of separating signal from noise

Lung Transplantation for Idiopathic Pulmonary Fibrosis

Fernando A. Atik, MD, Lars G. Svensson, MD, PhD, FACC, Eugene H

Presentation transcript:

Survival after valve replacement for aortic stenosis: Implications for decision making Tomislav Mihaljevic, MD, Edward R. Nowicki, MD, Jeevanantham Rajeswaran, MSc, Eugene H. Blackstone, MD, Luigi Lagazzi, MD, James Thomas, MD, Bruce W. Lytle, MD, Delos M. Cosgrove, MD The Journal of Thoracic and Cardiovascular Surgery Volume 135, Issue 6, Pages 1270-1279.e12 (June 2008) DOI: 10.1016/j.jtcvs.2007.12.042 Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Survival after AVR according to primary risk factors. Each symbol represents a death, vertical bars are 68% confidence limits equivalent to ±1 standard error, and numbers in parentheses are patients remaining at risk. Solid lines are parametric estimates. Dashed lines with corresponding color represent corresponding survival of an age, race, and sex-matched population. A, Severity of symptoms expressed as New York Heart Association classes I and II versus III and IV. Figure includes all patients in study. B, Severity of aortic stenosis expressed as native AV orifice area. For clarity, only patients with extreme values are depicted, with the remaining values between (15% had orifice area ≥ 0.85 cm2 and 9.3% had orifice area < 0.5 cm2). C, Severity of LV hypertrophy, expressed as LV mass index. For clarity, only patients with extreme values are depicted, with the remaining values between (15% had mass < 100 g/m2 and 15% had mass ≥ 185 g/m2). D, LV dysfunction. All patients are depicted. E, Age. All patients are depicted. F, Prosthesis size, expressed as prosthesis–patient size (Z value). For clarity, only patients with extreme values are depicted, with the remaining values between (15% had Z values > 0.5 and 13% had Z values ≤ –1.5). NYHA, New York Heart Association. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1270-1279.e12DOI: (10.1016/j.jtcvs.2007.12.042) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Survival after AVR according to primary risk factors. Each symbol represents a death, vertical bars are 68% confidence limits equivalent to ±1 standard error, and numbers in parentheses are patients remaining at risk. Solid lines are parametric estimates. Dashed lines with corresponding color represent corresponding survival of an age, race, and sex-matched population. A, Severity of symptoms expressed as New York Heart Association classes I and II versus III and IV. Figure includes all patients in study. B, Severity of aortic stenosis expressed as native AV orifice area. For clarity, only patients with extreme values are depicted, with the remaining values between (15% had orifice area ≥ 0.85 cm2 and 9.3% had orifice area < 0.5 cm2). C, Severity of LV hypertrophy, expressed as LV mass index. For clarity, only patients with extreme values are depicted, with the remaining values between (15% had mass < 100 g/m2 and 15% had mass ≥ 185 g/m2). D, LV dysfunction. All patients are depicted. E, Age. All patients are depicted. F, Prosthesis size, expressed as prosthesis–patient size (Z value). For clarity, only patients with extreme values are depicted, with the remaining values between (15% had Z values > 0.5 and 13% had Z values ≤ –1.5). NYHA, New York Heart Association. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1270-1279.e12DOI: (10.1016/j.jtcvs.2007.12.042) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Survival after AVR according to primary risk factors. Each symbol represents a death, vertical bars are 68% confidence limits equivalent to ±1 standard error, and numbers in parentheses are patients remaining at risk. Solid lines are parametric estimates. Dashed lines with corresponding color represent corresponding survival of an age, race, and sex-matched population. A, Severity of symptoms expressed as New York Heart Association classes I and II versus III and IV. Figure includes all patients in study. B, Severity of aortic stenosis expressed as native AV orifice area. For clarity, only patients with extreme values are depicted, with the remaining values between (15% had orifice area ≥ 0.85 cm2 and 9.3% had orifice area < 0.5 cm2). C, Severity of LV hypertrophy, expressed as LV mass index. For clarity, only patients with extreme values are depicted, with the remaining values between (15% had mass < 100 g/m2 and 15% had mass ≥ 185 g/m2). D, LV dysfunction. All patients are depicted. E, Age. All patients are depicted. F, Prosthesis size, expressed as prosthesis–patient size (Z value). For clarity, only patients with extreme values are depicted, with the remaining values between (15% had Z values > 0.5 and 13% had Z values ≤ –1.5). NYHA, New York Heart Association. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1270-1279.e12DOI: (10.1016/j.jtcvs.2007.12.042) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Survival after AVR according to primary risk factors. Each symbol represents a death, vertical bars are 68% confidence limits equivalent to ±1 standard error, and numbers in parentheses are patients remaining at risk. Solid lines are parametric estimates. Dashed lines with corresponding color represent corresponding survival of an age, race, and sex-matched population. A, Severity of symptoms expressed as New York Heart Association classes I and II versus III and IV. Figure includes all patients in study. B, Severity of aortic stenosis expressed as native AV orifice area. For clarity, only patients with extreme values are depicted, with the remaining values between (15% had orifice area ≥ 0.85 cm2 and 9.3% had orifice area < 0.5 cm2). C, Severity of LV hypertrophy, expressed as LV mass index. For clarity, only patients with extreme values are depicted, with the remaining values between (15% had mass < 100 g/m2 and 15% had mass ≥ 185 g/m2). D, LV dysfunction. All patients are depicted. E, Age. All patients are depicted. F, Prosthesis size, expressed as prosthesis–patient size (Z value). For clarity, only patients with extreme values are depicted, with the remaining values between (15% had Z values > 0.5 and 13% had Z values ≤ –1.5). NYHA, New York Heart Association. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1270-1279.e12DOI: (10.1016/j.jtcvs.2007.12.042) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Survival after AVR according to primary risk factors. Each symbol represents a death, vertical bars are 68% confidence limits equivalent to ±1 standard error, and numbers in parentheses are patients remaining at risk. Solid lines are parametric estimates. Dashed lines with corresponding color represent corresponding survival of an age, race, and sex-matched population. A, Severity of symptoms expressed as New York Heart Association classes I and II versus III and IV. Figure includes all patients in study. B, Severity of aortic stenosis expressed as native AV orifice area. For clarity, only patients with extreme values are depicted, with the remaining values between (15% had orifice area ≥ 0.85 cm2 and 9.3% had orifice area < 0.5 cm2). C, Severity of LV hypertrophy, expressed as LV mass index. For clarity, only patients with extreme values are depicted, with the remaining values between (15% had mass < 100 g/m2 and 15% had mass ≥ 185 g/m2). D, LV dysfunction. All patients are depicted. E, Age. All patients are depicted. F, Prosthesis size, expressed as prosthesis–patient size (Z value). For clarity, only patients with extreme values are depicted, with the remaining values between (15% had Z values > 0.5 and 13% had Z values ≤ –1.5). NYHA, New York Heart Association. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1270-1279.e12DOI: (10.1016/j.jtcvs.2007.12.042) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Survival after AVR according to primary risk factors. Each symbol represents a death, vertical bars are 68% confidence limits equivalent to ±1 standard error, and numbers in parentheses are patients remaining at risk. Solid lines are parametric estimates. Dashed lines with corresponding color represent corresponding survival of an age, race, and sex-matched population. A, Severity of symptoms expressed as New York Heart Association classes I and II versus III and IV. Figure includes all patients in study. B, Severity of aortic stenosis expressed as native AV orifice area. For clarity, only patients with extreme values are depicted, with the remaining values between (15% had orifice area ≥ 0.85 cm2 and 9.3% had orifice area < 0.5 cm2). C, Severity of LV hypertrophy, expressed as LV mass index. For clarity, only patients with extreme values are depicted, with the remaining values between (15% had mass < 100 g/m2 and 15% had mass ≥ 185 g/m2). D, LV dysfunction. All patients are depicted. E, Age. All patients are depicted. F, Prosthesis size, expressed as prosthesis–patient size (Z value). For clarity, only patients with extreme values are depicted, with the remaining values between (15% had Z values > 0.5 and 13% had Z values ≤ –1.5). NYHA, New York Heart Association. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1270-1279.e12DOI: (10.1016/j.jtcvs.2007.12.042) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Nomograms of 10-year survival after AVR from the multivariable analysis of death (Table 1). To produce these risk-adjusted depictions, values for the following variables were held constant (unless depicted in the graph): age, 73 years; no mitral regurgitation; AV orifice area, 0.7 cm2; New York Heart Association functional class I/II; date of operation, January 2004; LV mass index, 135 g/m−2; no ventricular arrhythmia; no previous cardiac operation; left main stenosis, ≥70%; left circumflex stenosis, >0%; smoker; peripheral arterial disease; hypertensive; nondiabetic; no renal disease; blood urea nitrogen, 19 mg/dL−1; creatinine clearance, 65 mL/min−1; hematocrit, 38%. Solid lines are parametric estimates, and dashed lines are asymmetric 68% confidence limits. Note the expanded vertical axes. A, LV mass index and AV orifice area. B, Prosthesis–patient Z value and LV mass index. C, Prosthesis–patient Z value and age. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1270-1279.e12DOI: (10.1016/j.jtcvs.2007.12.042) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Nomograms of 10-year survival after AVR from the multivariable analysis of death (Table 1). To produce these risk-adjusted depictions, values for the following variables were held constant (unless depicted in the graph): age, 73 years; no mitral regurgitation; AV orifice area, 0.7 cm2; New York Heart Association functional class I/II; date of operation, January 2004; LV mass index, 135 g/m−2; no ventricular arrhythmia; no previous cardiac operation; left main stenosis, ≥70%; left circumflex stenosis, >0%; smoker; peripheral arterial disease; hypertensive; nondiabetic; no renal disease; blood urea nitrogen, 19 mg/dL−1; creatinine clearance, 65 mL/min−1; hematocrit, 38%. Solid lines are parametric estimates, and dashed lines are asymmetric 68% confidence limits. Note the expanded vertical axes. A, LV mass index and AV orifice area. B, Prosthesis–patient Z value and LV mass index. C, Prosthesis–patient Z value and age. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1270-1279.e12DOI: (10.1016/j.jtcvs.2007.12.042) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Nomograms of 10-year survival after AVR from the multivariable analysis of death (Table 1). To produce these risk-adjusted depictions, values for the following variables were held constant (unless depicted in the graph): age, 73 years; no mitral regurgitation; AV orifice area, 0.7 cm2; New York Heart Association functional class I/II; date of operation, January 2004; LV mass index, 135 g/m−2; no ventricular arrhythmia; no previous cardiac operation; left main stenosis, ≥70%; left circumflex stenosis, >0%; smoker; peripheral arterial disease; hypertensive; nondiabetic; no renal disease; blood urea nitrogen, 19 mg/dL−1; creatinine clearance, 65 mL/min−1; hematocrit, 38%. Solid lines are parametric estimates, and dashed lines are asymmetric 68% confidence limits. Note the expanded vertical axes. A, LV mass index and AV orifice area. B, Prosthesis–patient Z value and LV mass index. C, Prosthesis–patient Z value and age. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1270-1279.e12DOI: (10.1016/j.jtcvs.2007.12.042) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Time -related survival after AVR. A, Survival Time -related survival after AVR. A, Survival. Each symbol represents a death, vertical bars 68% are confidence limits, and numbers in parentheses are patients remaining at risk. Solid line represents parametric estimates enclosed within 68% confidence limits. Dash-dot-dash line is survival for the age, race, and sex-matched population. B, Instantaneous risk of death (hazard function). Estimates are enclosed within 68% confidence limits. Dash-dot-dash line represents hazard function for the age, race, and sex-matched population. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1270-1279.e12DOI: (10.1016/j.jtcvs.2007.12.042) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Ten -year survival after aortic value replacement according to interplay of primary risk factors. The 9 panels represent solutions to the multivariable equation by the indicated values of age, LV mass index, native AV size, and prosthesis–patient size (Z value). Solid lines represent parametric estimates enclosed within 68% confidence limits. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1270-1279.e12DOI: (10.1016/j.jtcvs.2007.12.042) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Bicuspid AV morphology according to age at AV replacement Bicuspid AV morphology according to age at AV replacement. Closed circles represent percentage of patients with bicuspid valves in decile age ranges; solid line is a trend line. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1270-1279.e12DOI: (10.1016/j.jtcvs.2007.12.042) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Nomogram for converting prosthesis–patient Z value and body surface area to Perimount pericardial prosthesis (Edwards Lifesciences, Irvine, Calif) label size. When a patient with a critical combination of risk factors (eg, older age and large LV mass index) is identified, use body surface area and minimum desired prosthesis–patient Z value (−1.5, dashed horizontal line) to convert to prosthesis label size for implantation. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1270-1279.e12DOI: (10.1016/j.jtcvs.2007.12.042) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions