Outcomes Following Urgent/emergent Minimally Invasive Aortic Valve Replacement
Joshua C. Chao, Alexis K. Okoh, Marlena E. Sabatino, Lauren A. Salgueiro, Jigesh Baxi, Fady Soliman, Cassandra Soto, Hirohisa Ikegami, Anthony Lemaire, Mark J. Russo, Leonard Y. Lee.
Robert Wood Johnson University Hospital, Department of Surgery, Division of Cardiothoracic Surgery; Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Background: Minimally invasive aortic valve replacement (mini-AVR) has demonstrated excellent outcomes, including with respect to mortality and hospital length of stay. Urgent/emergent surgery in other contexts yields worse outcomes when compared to elective surgery. The aim of this study was to compare outcomes of urgent/emergent mini-AVR versus elective mini-AVR. Methods: A prospectively maintained database of a single center was used to identify patients who underwent isolated urgent/emergent versus elective mini-AVR between 2012 and 2018. Outcomes assessed were in-hospital major adverse events, 30-day mortality, and post-operative length of stay (LOS). Logistic regression models were used to identify independent predictors of 30-day mortality after urgent/emergent mini-AVR. Results: Out of 607 patients who underwent a mini-AVR, 235 were urgent/emergent (STS score: 5±2), with the remaining 372 being elective (STS score:4±2). Compared to elective patients, urgent/emergent patients had more significant comorbidities at baseline (CKD: 2% in elective patients vs. 7% in urgent/emergent patients, p=0.005, CVA:11% vs. 16%; p=0.005, CHF:22% vs. 47%; p<0.001). Intra-operatively, urgent/emergent cases utilized more blood products (PRBC, FFP) than elective cases. Post-operative LOS in the ICU (51 vs 31hrs; p=0.034) and overall (8 vs. 6 days; p<0.001) was longer for urgent/emergent patients than elective patients. Rates of major and/or life-threatening bleeding, stroke, and conversion to full sternotomy, were similar between the 2 groups. However, in-hospital mortality was higher in the urgent/emergent group compared to the elective group (5% vs. 1%; p=0.014). In patients undergoing urgent/emergent mini-AVR, high STS risk score (p=0.005), post-operative acute renal failure (p=0.044), prolonged pre-operative LOS (p=0.002), and mechanical ventilation (p=0.044) were associated with increased risk of 30-day mortality. Conclusion: Patients undergoing urgent/emergent mini-AVR experienced worse in-hospital outcomes and utilized more resources compared to those proceeding electively. Both pre-and post-operative factors were associated with increased 30-day mortality risk in urgent/emergent mini-AVR patients. Optimization of pre-operative predictors could contribute to reduced risk of mortality and shorter LOS.
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