The Post-cardiotomy Syndrome Is One Of The Factor With Negative Impact On Long-term Survival After Surgical Aortic Valve Replacement
Marcin Kaczmarczyk1, Tomasz Hrapkowicz1, Krzysztof Filipiak2, Krzysztof Kubacki1, Michał Zembala1.
1Silesian Center for Heart Diseases, Zabrze, Poland, 2Cardiac Surgery Department Pomeranian Medical University, Szczecin, Poland.
BACKGROUND:With the development of new minimally invasive techniques, the need to reassess long-term results after surgical aortic valve replacement (sAVR) has becoming increasingly expected. The aim of this study was to evaluate long-term survival after sAVR depending on the surgical technique used.METHODS:Total of 2147 patients who underwent sAVR at our institution from 01.2006 to 12.2017 have been analyzed. Two surgical approaches have been performed, among which 29% were minimally invasive through J-shaped ministernotomy (MIAVR) and 71% conventional through full sternotomy (FSAVR). For the purposes of the study, three types of predictors have been specified. The first was determined by patient dependent factors, while the second consisted of intraoperative measures and early in-hospital outcomes. The mini-invasive indicator represented the third predictor type. An event was defined by death from all causes. Multivariate Cox regression has been applied to build an independent Cox predictive survival model.RESULTS:Our Cox predictive model showed similar probability of 11 years survival for MIAVR compared with FSAVR [HR 1,02; p=0,85]. Postoperative cardiac, renal and neurological complications revealed the strongest prediction of shorter survival, whereas preoperative chronic lung disease and atherosclerosis obliterans appeared as the most powerful patient-dependent predictors. Inotropic support contributed to a higher long-term mortality risk [HR=1,32; p=0,04]. The patients with aortic annulus equal 21mm or less were 61% more likely to die earlier, if they received a bioprosthesis [HR=1,58; p=0,01]. A surprising finding was that the patients who experienced the post-cardiotomy syndrome during hospitalization were 35% more likely to die than others [HR=0,53; p=0,04](Tab.1).CONCLUSIONS:MIAVR has been proved to provide the same long-term survival as standard FSAVR. Early postoperative adverse events and interactions between the type and size of implanted prosthesis have the greatest impact on long-term mortality risk. While reaching an independent prognostic significance, the latent post-cardiotomy syndrome can negatively affect long-term survival after sAVR. Those patients, who have been properly diagnosed and appropriately treated because of such complication, have significantly higher survival probability against others. 
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