Prognostic utility of risk scores at predicting mortality and morbidity after combined aortic valve replacement and coronary artery bypass grafting

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prevalence; and as a gatekeeper to invasive angiography for those after equivocal functional testing or those who are troponin positive. Disease prevalence is higher in the latter two groups. http://dx.doi.org/10.1016/j.hlc.2015.04.113 P16 Prognostic utility of risk scores at predicting mortality and morbidity after combined aortic valve replacement and coronary artery bypass grafting T. Wang 1*, D. Choi 1, G. Gamble 2, T. Ramanathan 1, P. Ruygrok 1 1

Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, NZ 2 Department of Medicine, University of Auckland, Auckland, NZ * Corresponding author. Background: Aortic valve replacement (AVR) and/or coronary artery bypass grafting (CABG) make up the majority of cardiac surgeries with increasing demand as the population ages. Accuracy of risk stratification is important, especially as interventional aortic valve and coronary procedures continue to blossom, but have been rarely studied for the combined AVR+CABG operation. We compared the prognostic utility of EuroSCORE, EuroSCORE II and Society of Thoracic Surgeon’s (STS) Score for AVR+CABG. Methods: All patients undergoing AVR+CABG at Auckland City Hospital during 2005-2012 were included, with the three risk scores calculated and their discrimination and calibration for mortality and morbidities assessed. Results: 450 patients with AVR+CABG were included, with mean follow-up of 4.7 years. Operative mortality was 6.4% (29), and mean scores were EuroSCORE 12.5+/-11.1%, EuroSCORE II 6.6+/-6.1% and STS Score 5.5+/-4.4%. C-statistics were 0.587, 0.669 and 0.699 respectively for operative mortality, Hosmer-Lemeshow test P-values were 0.064, 0.718 and 0.567, and Brier Score 0.716, 0.585 and 0.588. Independent predictors of operative mortality were history of myocardial infarction and impaired renal function. STS score also was the best score at detecting late mortality (c=0.643), composite morbidity (c=0.627), stroke (c=0.642), prolonged ventilation>24 hours (c=0.642), and return to theatre (c=0.612). Conclusion: The STS score has the best discrimination (albeit moderate) for mortality and most complications after AVR+CABG, while its calibration was similar to EuroSCORE II and better than EuroSCORE. It should therefore be used in risk stratification and also consideration of surgical or percutaneous approach in those with concurrent aortic valve and coronary artery disease. http://dx.doi.org/10.1016/j.hlc.2015.04.114 P17 Eight-year cohort study of octogenarians undergoing aortic valve replacement with or without concurrent coronary artery bypass grafting

Abstracts

T. Wang *, D. Choi, T. Ramanathan, P. Ruygrok Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, NZ * Corresponding author. Background: Given the introduction of transcatheter aortic valve implantation (TAVI), there is significant interest in evaluating outcomes of aortic valve replacement (AVR) with or without(+/-) concurrent coronary artery bypass grafting (CABG) especially in high-risk patients. We reviewed the characteristics and outcomes of octogenarians undergoing isolated AVR and AVR+CABG. Methods: All patients 80 years of age or older undergoing AVR+/-CABG at Auckland City Hospital during 2005-2012 were included, and their characteristics and outcomes analysed. Results: There were 93 and 104 octogenarians respectively undergoing isolated AVR and AVR+CABG with mean follow-up of 4.4+/-2.2 years and 4.1+/-2.3 years. On average 10 more cases of AVR+/-CABG per year were performed since 2010 when TAVI was started at our centre. AVR+CABG patients have significantly higher proportion with history of myocardial infarction, left main and three vessel disease (all P<0.005), higher average CCS and NYHA class (both P<0.001), impaired renal function (P=0.019), higher STS score (6.9% vs 4.9%, <0.001) and longer cardiopulmonary bypass and cross-clamp time (both P<0.001) compared to AVR. They also had significantly higher rate of operative mortality (6.7% vs 0.0%, P=0.015) and prolonged ventilation>24 hours (23.1% vs 10.7%, P<0.001), but similar late mortality (P=0.195). Survival at 1, 3 and 5 years were 94.6%, 82.6% and 73.0% for AVR and 91.3%, 86.1% and 67.6% for AVR+CABG. Conclusion: AVR+CABG had significantly higher but acceptable operative mortality in octogenarians than AVR. These factors are important for the consideration of patients undergoing AVR+/-CABG or TAVI+/-percutaneous coronary intervention, where age alone should not exclude someone from surgery. http://dx.doi.org/10.1016/j.hlc.2015.04.115 P18 Aortic valve replacement with or without coronary artery bypass grafting: stroke outcomes and predictors T. Wang *, T. Ramanathan, D. Choi, P. Ruygrok Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, NZ * Corresponding author. Background: Stroke is arguably the most important and devastating non-mortality complication after cardiac surgery, including comparisons between aortic valve replacement (AVR) and transcatheter aortic valve implantation. We analysed the rates and predictors of stroke after AVR with or without concurrent coronary artery bypass grafting (CABG). Methods: All patients undergoing AVR+/-CABG at Auckland City Hospital during 2005-2012 were included, and analyses conducted to identify predictors for post-operative