The impact of specific preoperative organ dysfunction in patients undergoing aortic valve replacement.

BACKGROUND: Optimizing treatment strategies to risk profile patients undergoing aortic valve replacement remains a priority. The role that specific and combinations of preoperative organ dysfunction (OD) plays in informing these decisions remains uncertain. This study sought to determine the relative effect that OD in particular systems has on short- and long-term outcomes.

METHODS: A total of 1,759 aortic valve replacement cases with and without coronary artery bypass grafting performed from January 2002 to June 2010 at Emory University are the basis for this retrospective analysis. Patients were classified by the presence or absence of preoperative OD: (1) cardiac: congestive heart failure (ejection fraction <0.35), (2) pulmonary: forced expiratory volume in 1 second less than 50% predicted, (3) neurologic (prior stroke), and (4) renal: chronic renal failure. The impact of individual and combined OD on outcomes was evaluated. Kaplan-Meier survival estimates and Cox regression models were used to assess the relationship between OD and long-term survival.

RESULTS: A total of 513 patients (29.2%) had at least one OD, including 95 patients (5.4%) with more than one OD. Organ dysfunction in each organ system was associated with poorer survival. Renal (hazard ratio, 3.90) and pulmonary (hazard ratio, 2.40) OD patients had poorer long-term survival, including 30-day mortality. Seven-year survival for OD patients is as follows: prior stroke, 48.6%; severe chronic obstructive pulmonary disease, 30.8%; congestive heart failure, 55.9%; and chronic renal failure, 11.7%. The sequential addition of OD systems was a powerful predictor of poorer long-term survival.

CONCLUSIONS: The presence of chronic renal failure most profoundly decreases survival, followed by severe chronic obstructive pulmonary disease and prior stroke. Furthermore, multiple OD systems significantly decrease short- and long-term survival.