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Predictors of Mortality After Aortic Valve Replacement for Severe Aortic Stenosis: The Auckland Experience
565 Outcomes After Isolated CABG Surgery Related to Smoking Status S. Bappayya 1,∗ , A. Saxena 1,2 , L. Shan 1,2 , D. Dinh 2 , J. Smith 2 , G. Shardey 2 , A. Newcomb 1,2 1 University 2 St
of Melbourne, Australia Vincent’s Hospital, Melbourne, Australia
Background: Cigarette smoking has been implicated with adverse outcomes following coronary artery bypass grafting (CABG) surgery. To date, evidence linking smoking status on long-term mortality following CABG remains ambiguous. While advances in the practise of CABG now allow older patients with more comorbidities to undergo surgery, mortality following CABG continues to fall. There is therefore a need to re-evaluate the influence of preoperative smoking status on long-term mortality following CABG in the current era. Methods: ANZSCTS database was accessed to identify 21,486 patients undergoing CABG between 1 June 2001 and 31 December 2009 in this study. Preoperative characteristics, early outcomes and long-term survival of current smokers, previous smokers and non-smokers were compared using logistic regression, Kaplan–Meier survival curve and long-rank test methods. Results: Current smokers had a significantly higher length of ICU stay (p < 0.01) but their post-procedure length of hospital stay was lowest compared with nonsmokers (p = 0.023). Logistic regression revealed smoking status was not an independent predictor for 30-day mortality. After adjusting for differences in patient variables, the incidence of late mortality was higher in both current smokers (OR, 1.41; p < 0.001) and previous smokers (OR, 1.73; p < 0.001) compared to non-smokers. Conclusion: This study presents a strong positive relationship between smoking status and long-term mortality following CABG. This study presents additional evidence to the debate on the consideration of smoking status in patient selection for CABG. It also lends weight to preventive efforts at all time points for health care professionals. http://dx.doi.org/10.1016/j.hlc.2013.05.567 566 Predictors of Mortality After Aortic Valve Replacement for Severe Aortic Stenosis: The Auckland Experience T. Oh 1,∗ , D. Eade 1 , K. Sidhu 1 , N. Kang 2 , R. Stewart 1 1 Green 2 Green
Lane Cardiovascular Services, New Zealand Lane Cardiothoracic Surgical Unit, New Zealand
Background: Identifying predictors of mortality after aortic valve replacement for severe aortic stenosis may be relevant to the selection of elderly patients for intervention, and its’ timing. Methods: In a random sample of 271 patients who underwent aortic valve replacement (AVR) for severe aortic stenosis (AS) between 1 January 2005 and 31 December
CSANZ 2013 Abstracts
S239
2012 at Auckland City Hospital pre-operative patient characteristics were evaluated to identify predictors of mortality after AVR. Medical records to the time of referral were systematically reviewed without knowledge of outcomes. After un-blinding clinical, echocardiographic, biochemical and electrocardiographic data were compared for 42 (16%) patients who died after AVR with 229 patients alive at follow-up. Results: Among the 42 post-operative deaths, 14 (33%) were early mortality (within 30 post-operative days). The mean survival for the other 28 patients who died after AVR was 25 ± 18 months. Variables associated with mortality were haemoglobin 130 ± 20 vs. 136 ± 17 (p = 0.042), renal function (eGFR) 65 ± 40 vs. 77 ± 31 (p = 0.0014), history of heart failure 48% vs. 21% (p = 0.0003), history of atrial fibrillation 40% vs. 21% (p = 0.0085) and administration of loop diuretics 60% vs. 31% (p = 0.0004) for patients who died and were alive respectively. Smaller mean aortic valve area, older age, syncope and history of angina before AVR were not significantly associated with increased mortality after AVR. Conclusions: Both cardiac and non-cardiac factors predict mortality after AVR. Further research is needed to determine whether steps to reduce development of persistent AF, which could include earlier intervention in patients with severe AS, will improve long term outcomes after AVR. http://dx.doi.org/10.1016/j.hlc.2013.05.568 567 Saphenous Vein to Internal Mammary Artery End to End Composite Grafts for Coronary Artery Bypass: Late Follow Up J. Thakkar ∗ , H. Paterson ∗ , K. Byth, A.R. Denniss Westmead Hospital, Australia Background: Lengthening a free internal mammary artery (IMA) graft with a proximal end to end segment of saphenous vein (SV) removes the problem of limited length but outcomes have not been reported. Methodology: Ninety-two consecutive patients who underwent end to end composite SV-IMA grafts underwent late follow up. Results: The mean follow up was 10.5 years (1–17 years). Thirty-one patients underwent late angiography. Kaplan–Meier and logistic regression analyses demonstrated the following. Survival at 10 and 15 years was 90% and 75%. Reintervention (surgery or angioplasty) at 10 years was 10%. Sequential grafts had a greater patency than single grafts (p = 0.01). Occlusion or stenosis in the proximal segment of the composite graft occurred in 10 patients within six years of surgery (mean 3.1 years) but was not seen thereafter. When proximal occlusion of the composite sequential grafts occurred, the IMA portion of the graft from the first distal anastomosis remained patent. For patients with non-LAD (left anterior descending artery) double vessel disease, significant progression
ABSTRACTS
Heart, Lung and Circulation 2013;22:S126–S266
of Melbourne, Australia Vincent’s Hospital, Melbourne, Australia
Background: Cigarette smoking has been implicated with adverse outcomes following coronary artery bypass grafting (CABG) surgery. To date, evidence linking smoking status on long-term mortality following CABG remains ambiguous. While advances in the practise of CABG now allow older patients with more comorbidities to undergo surgery, mortality following CABG continues to fall. There is therefore a need to re-evaluate the influence of preoperative smoking status on long-term mortality following CABG in the current era. Methods: ANZSCTS database was accessed to identify 21,486 patients undergoing CABG between 1 June 2001 and 31 December 2009 in this study. Preoperative characteristics, early outcomes and long-term survival of current smokers, previous smokers and non-smokers were compared using logistic regression, Kaplan–Meier survival curve and long-rank test methods. Results: Current smokers had a significantly higher length of ICU stay (p < 0.01) but their post-procedure length of hospital stay was lowest compared with nonsmokers (p = 0.023). Logistic regression revealed smoking status was not an independent predictor for 30-day mortality. After adjusting for differences in patient variables, the incidence of late mortality was higher in both current smokers (OR, 1.41; p < 0.001) and previous smokers (OR, 1.73; p < 0.001) compared to non-smokers. Conclusion: This study presents a strong positive relationship between smoking status and long-term mortality following CABG. This study presents additional evidence to the debate on the consideration of smoking status in patient selection for CABG. It also lends weight to preventive efforts at all time points for health care professionals. http://dx.doi.org/10.1016/j.hlc.2013.05.567 566 Predictors of Mortality After Aortic Valve Replacement for Severe Aortic Stenosis: The Auckland Experience T. Oh 1,∗ , D. Eade 1 , K. Sidhu 1 , N. Kang 2 , R. Stewart 1 1 Green 2 Green
Lane Cardiovascular Services, New Zealand Lane Cardiothoracic Surgical Unit, New Zealand
Background: Identifying predictors of mortality after aortic valve replacement for severe aortic stenosis may be relevant to the selection of elderly patients for intervention, and its’ timing. Methods: In a random sample of 271 patients who underwent aortic valve replacement (AVR) for severe aortic stenosis (AS) between 1 January 2005 and 31 December
CSANZ 2013 Abstracts
S239
2012 at Auckland City Hospital pre-operative patient characteristics were evaluated to identify predictors of mortality after AVR. Medical records to the time of referral were systematically reviewed without knowledge of outcomes. After un-blinding clinical, echocardiographic, biochemical and electrocardiographic data were compared for 42 (16%) patients who died after AVR with 229 patients alive at follow-up. Results: Among the 42 post-operative deaths, 14 (33%) were early mortality (within 30 post-operative days). The mean survival for the other 28 patients who died after AVR was 25 ± 18 months. Variables associated with mortality were haemoglobin 130 ± 20 vs. 136 ± 17 (p = 0.042), renal function (eGFR) 65 ± 40 vs. 77 ± 31 (p = 0.0014), history of heart failure 48% vs. 21% (p = 0.0003), history of atrial fibrillation 40% vs. 21% (p = 0.0085) and administration of loop diuretics 60% vs. 31% (p = 0.0004) for patients who died and were alive respectively. Smaller mean aortic valve area, older age, syncope and history of angina before AVR were not significantly associated with increased mortality after AVR. Conclusions: Both cardiac and non-cardiac factors predict mortality after AVR. Further research is needed to determine whether steps to reduce development of persistent AF, which could include earlier intervention in patients with severe AS, will improve long term outcomes after AVR. http://dx.doi.org/10.1016/j.hlc.2013.05.568 567 Saphenous Vein to Internal Mammary Artery End to End Composite Grafts for Coronary Artery Bypass: Late Follow Up J. Thakkar ∗ , H. Paterson ∗ , K. Byth, A.R. Denniss Westmead Hospital, Australia Background: Lengthening a free internal mammary artery (IMA) graft with a proximal end to end segment of saphenous vein (SV) removes the problem of limited length but outcomes have not been reported. Methodology: Ninety-two consecutive patients who underwent end to end composite SV-IMA grafts underwent late follow up. Results: The mean follow up was 10.5 years (1–17 years). Thirty-one patients underwent late angiography. Kaplan–Meier and logistic regression analyses demonstrated the following. Survival at 10 and 15 years was 90% and 75%. Reintervention (surgery or angioplasty) at 10 years was 10%. Sequential grafts had a greater patency than single grafts (p = 0.01). Occlusion or stenosis in the proximal segment of the composite graft occurred in 10 patients within six years of surgery (mean 3.1 years) but was not seen thereafter. When proximal occlusion of the composite sequential grafts occurred, the IMA portion of the graft from the first distal anastomosis remained patent. For patients with non-LAD (left anterior descending artery) double vessel disease, significant progression
ABSTRACTS
Heart, Lung and Circulation 2013;22:S126–S266