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Short- and Long-Term Heart Transplant Recipient Outcomes Are Adversely Affected by Donor pH
S26
Scientific Forum Abstracts
Postoperative Outcomes of Surgical Sutureless Aortic Valve Replacement vs Transcatheter Aortic Valve Implantation for Severe Symptomatic Aortic Stenosis Jane Chung, Anastasia Postoev, Asia Filatov, Latin Ladoris, Angel Farinas, MD, Christian X Cruz Pico, MD, Angelina Postoev, MD, FACS, Christopher Ibikunle, MD, FACS, Aliu Sanni, MD Georgia Regents University/University of Georgia Medical Partnership, Athens, GA; Georgia Surgicare, Loganville, GA INTRODUCTION: High surgical risk patients with severe symptomatic aortic stenosis (SSAS) are currently being managed with transcatheter aortic valve implantation (TAVI). Limitations of this procedure include increased cost, resultant paravalvular leakage, coronary occlusion, and possible aortic rupture. A new surgical option for this group has emerged with the advent of surgical sutureless aortic valve replacement (SU-AVR). This study reviews the postoperative outcomes of SU-AVR in comparison with TAVI. METHODS: A systematic review was conducted, identifying all relevant studies with comparative data on SU-AVR vs TAVI. The primary endpoint was the incidence of postoperative mortality and paravalvular leaks. Other postoperative outcomes measured were the incidence of postoperative atrial fibrillation (AF), stroke, acute myocardial infarction (AMI), and acute renal failure (ARF). Statistical analysis was done using SPSS to calculate odds ratios and 95% confidence intervals. RESULTS: Five studies were quantitatively assessed and included for meta-analysis of 2 prospective and 3 retrospective studies. There 303 SU-AVR patients and 417 TAVI patients. The SU-AVR was associated with reduced rates of postoperative mortality (odds ratio [OR] 0.19; 95% CI, 0.07-0.57) and paravalvular leaks (OR 0.12; 95% CI, 0.07-0.21) when compared with TAVI. There were no significant differences between SU-AVR and TAVI for the occurrence of postoperative AF (OR 1.05; 95% CI, 0.59-1.89), stroke (OR 0.34; 95% CI, 0.09-1.3), AMI (OR 0.37; 95% CI, 0.04-3.3), and ARF (OR 0.74; 95% CI, 0.29-1.9). CONCLUSIONS: Surgical sutureless aortic valve replacement is a valid alternative to TAVI in high risk surgical patients because it is associated with lower incidence of postoperative mortality and paravalvular leaks. Prognostic Implication of Preoperative Chronic Kidney Disease and Anemia in Patients Undergoing Coronary Artery Bypass Graft Surgery Takuya Ogami, Yuya Matsue, MD, PhD, Nobuyasu Kano, MD, FACS, Hiroaki Tanabe, MD Kameda Medical Center, Chiba, Japan INTRODUCTION: Chronic kidney disease (CKD) and anemia have been independently shown as preoperative risk factors of coronary artery bypass graft (CABG) surgery. However, the prognostic implication of coexistence of these 2 factors has not been well elucidated. We evaluated the relationship between the 2 factors and prognosis in CABG surgery.
J Am Coll Surg
METHODS: We retrospectively analyzed and included consecutive patients undergoing elective CABG surgery from 2004 through 2014 at a community hospital in Japan. The patients were classified into 4 groups depending on the presence or absence of preoperative CKD and anemia. The presence of CKD was defined as estimated glomerular filtration rate below 60 mL/min/1.73 m2. We assessed the composite outcomes of cerebral infarction and sudden death after discharge, admission for heart failure, and revascularization. RESULTS: A total of 510 patients (median 71 years old, 73.3% male) were included. There were 244 (47.8%) non-CKD/noanemia patients, 28 (5.5%) with CKD/no-anemia, 149 (29.2%) with non-CKD/anemia, and 89 (17.5%) with CKD/anemia. The median follow-up period was 2.8 years. Multivariate analysis identified that neither the CKD/no-anemia group (hazard ratio [HR] 1.62; 95% CI 0.65-4.01, p¼0.297) nor the no-CKD/anemia group (HR 1.27; 95% CI 0.73-2.22, p¼0.404) had significantly worse prognosis when compared with the no-CKD/no-anemia group. However, the CKD/anemia group had a significantly higher risk of the composite outcomes (HR 3.08, 95% CI 1.68-5.64; p<0.001). CONCLUSIONS: The presence of both CKD and anemia before CABG surgery is synergistically associated with worse outcomes in coronary artery disease patients. Short- and Long-Term Heart Transplant Recipient Outcomes Are Adversely Affected by Donor pH Carol W Chen, MD, Ann C Gaffey, MD, Mariell Jessup, MD, Michael A Acker, MD, Pavan Atluri, MD, FACS University of Pennsylvania, Philadelphia, PA INTRODUCTION: With the expansion of organ donation criteria, donor management goals help to standardize preoperative optimization of organs to achieve a better outcome in the transplant recipient. One accepted goal is strict maintenance of physiologic arterial pH between 7.3 and 7.45, though this range has not been rigorously validated. We undertook this study to analyze the impact of donor pH on post-heartetransplantation outcomes using the United Network of Organ Sharing (UNOS) database. METHODS: We retrospectively reviewed heart transplantation outcomes in the UNOS database between October 1, 1987 and December 31, 2013. Specifically, we examined the all-cause mortality of transplant recipients in the first 36 months after surgery grouped by preoperative donor pH. Recipient survival was compared among 5 pH ranges: 5.00-5.99, 6.00-6.99, 7.00-7.29, 7.30-7.49, and 7.50-7.80. RESULTS: Of 21,456 donors with recorded pretransplant pH, 56 (0.3%) had pH between 5.00 and 5.99; 50 (0.2%) had pH 6.00-6.99; 914 (4.3%) had pH 7.00-7.29; 18,671 (87.0%) had pH 7.30-7.49; and 1,765 (8.2%) had pH 7.50-7.80. Kaplan-Meier survival analysis at 36 months showed 75%
Vol. 221, No. 4S1, October 2015
Scientific Forum Abstracts
S27
pH group
Total, n
Deaths, n
n
%
survival in recipients of pH 5.00-5.99 hearts; 84% survival in pH 6.00-6.99; 89% survival in pH 7.00-7.29; 88% survival in pH 7.30-7.49; and 89% survival in pH 7.50-7.80 (log-rank p¼0.024).
5.00-5.99 6.00-6.99 7.00-7.29 7.30-7.49 7.50-7.80 Overall
56 50 914 18,671 1,765 21,456
14 8 102 2,161 202 2,487
42 42 812 16,510 1,563 18,969
75.0 84.0 88.8 88.4 88.6 88.4
CONCLUSIONS: Donor blood pH is an important factor in heart recipient survival, with worse outcomes seen in donor pH less than 7. Donor hearts that fall outside of the strict pH criteria between 7.3-7.45 should not be discarded because outcomes are similar among patients who received hearts with donor pH between 7.0 and 7.8.
Table. Percent Recipient Survival by Donor pH during 36 Months Survivors
Scientific Forum Abstracts
Postoperative Outcomes of Surgical Sutureless Aortic Valve Replacement vs Transcatheter Aortic Valve Implantation for Severe Symptomatic Aortic Stenosis Jane Chung, Anastasia Postoev, Asia Filatov, Latin Ladoris, Angel Farinas, MD, Christian X Cruz Pico, MD, Angelina Postoev, MD, FACS, Christopher Ibikunle, MD, FACS, Aliu Sanni, MD Georgia Regents University/University of Georgia Medical Partnership, Athens, GA; Georgia Surgicare, Loganville, GA INTRODUCTION: High surgical risk patients with severe symptomatic aortic stenosis (SSAS) are currently being managed with transcatheter aortic valve implantation (TAVI). Limitations of this procedure include increased cost, resultant paravalvular leakage, coronary occlusion, and possible aortic rupture. A new surgical option for this group has emerged with the advent of surgical sutureless aortic valve replacement (SU-AVR). This study reviews the postoperative outcomes of SU-AVR in comparison with TAVI. METHODS: A systematic review was conducted, identifying all relevant studies with comparative data on SU-AVR vs TAVI. The primary endpoint was the incidence of postoperative mortality and paravalvular leaks. Other postoperative outcomes measured were the incidence of postoperative atrial fibrillation (AF), stroke, acute myocardial infarction (AMI), and acute renal failure (ARF). Statistical analysis was done using SPSS to calculate odds ratios and 95% confidence intervals. RESULTS: Five studies were quantitatively assessed and included for meta-analysis of 2 prospective and 3 retrospective studies. There 303 SU-AVR patients and 417 TAVI patients. The SU-AVR was associated with reduced rates of postoperative mortality (odds ratio [OR] 0.19; 95% CI, 0.07-0.57) and paravalvular leaks (OR 0.12; 95% CI, 0.07-0.21) when compared with TAVI. There were no significant differences between SU-AVR and TAVI for the occurrence of postoperative AF (OR 1.05; 95% CI, 0.59-1.89), stroke (OR 0.34; 95% CI, 0.09-1.3), AMI (OR 0.37; 95% CI, 0.04-3.3), and ARF (OR 0.74; 95% CI, 0.29-1.9). CONCLUSIONS: Surgical sutureless aortic valve replacement is a valid alternative to TAVI in high risk surgical patients because it is associated with lower incidence of postoperative mortality and paravalvular leaks. Prognostic Implication of Preoperative Chronic Kidney Disease and Anemia in Patients Undergoing Coronary Artery Bypass Graft Surgery Takuya Ogami, Yuya Matsue, MD, PhD, Nobuyasu Kano, MD, FACS, Hiroaki Tanabe, MD Kameda Medical Center, Chiba, Japan INTRODUCTION: Chronic kidney disease (CKD) and anemia have been independently shown as preoperative risk factors of coronary artery bypass graft (CABG) surgery. However, the prognostic implication of coexistence of these 2 factors has not been well elucidated. We evaluated the relationship between the 2 factors and prognosis in CABG surgery.
J Am Coll Surg
METHODS: We retrospectively analyzed and included consecutive patients undergoing elective CABG surgery from 2004 through 2014 at a community hospital in Japan. The patients were classified into 4 groups depending on the presence or absence of preoperative CKD and anemia. The presence of CKD was defined as estimated glomerular filtration rate below 60 mL/min/1.73 m2. We assessed the composite outcomes of cerebral infarction and sudden death after discharge, admission for heart failure, and revascularization. RESULTS: A total of 510 patients (median 71 years old, 73.3% male) were included. There were 244 (47.8%) non-CKD/noanemia patients, 28 (5.5%) with CKD/no-anemia, 149 (29.2%) with non-CKD/anemia, and 89 (17.5%) with CKD/anemia. The median follow-up period was 2.8 years. Multivariate analysis identified that neither the CKD/no-anemia group (hazard ratio [HR] 1.62; 95% CI 0.65-4.01, p¼0.297) nor the no-CKD/anemia group (HR 1.27; 95% CI 0.73-2.22, p¼0.404) had significantly worse prognosis when compared with the no-CKD/no-anemia group. However, the CKD/anemia group had a significantly higher risk of the composite outcomes (HR 3.08, 95% CI 1.68-5.64; p<0.001). CONCLUSIONS: The presence of both CKD and anemia before CABG surgery is synergistically associated with worse outcomes in coronary artery disease patients. Short- and Long-Term Heart Transplant Recipient Outcomes Are Adversely Affected by Donor pH Carol W Chen, MD, Ann C Gaffey, MD, Mariell Jessup, MD, Michael A Acker, MD, Pavan Atluri, MD, FACS University of Pennsylvania, Philadelphia, PA INTRODUCTION: With the expansion of organ donation criteria, donor management goals help to standardize preoperative optimization of organs to achieve a better outcome in the transplant recipient. One accepted goal is strict maintenance of physiologic arterial pH between 7.3 and 7.45, though this range has not been rigorously validated. We undertook this study to analyze the impact of donor pH on post-heartetransplantation outcomes using the United Network of Organ Sharing (UNOS) database. METHODS: We retrospectively reviewed heart transplantation outcomes in the UNOS database between October 1, 1987 and December 31, 2013. Specifically, we examined the all-cause mortality of transplant recipients in the first 36 months after surgery grouped by preoperative donor pH. Recipient survival was compared among 5 pH ranges: 5.00-5.99, 6.00-6.99, 7.00-7.29, 7.30-7.49, and 7.50-7.80. RESULTS: Of 21,456 donors with recorded pretransplant pH, 56 (0.3%) had pH between 5.00 and 5.99; 50 (0.2%) had pH 6.00-6.99; 914 (4.3%) had pH 7.00-7.29; 18,671 (87.0%) had pH 7.30-7.49; and 1,765 (8.2%) had pH 7.50-7.80. Kaplan-Meier survival analysis at 36 months showed 75%
Vol. 221, No. 4S1, October 2015
Scientific Forum Abstracts
S27
pH group
Total, n
Deaths, n
n
%
survival in recipients of pH 5.00-5.99 hearts; 84% survival in pH 6.00-6.99; 89% survival in pH 7.00-7.29; 88% survival in pH 7.30-7.49; and 89% survival in pH 7.50-7.80 (log-rank p¼0.024).
5.00-5.99 6.00-6.99 7.00-7.29 7.30-7.49 7.50-7.80 Overall
56 50 914 18,671 1,765 21,456
14 8 102 2,161 202 2,487
42 42 812 16,510 1,563 18,969
75.0 84.0 88.8 88.4 88.6 88.4
CONCLUSIONS: Donor blood pH is an important factor in heart recipient survival, with worse outcomes seen in donor pH less than 7. Donor hearts that fall outside of the strict pH criteria between 7.3-7.45 should not be discarded because outcomes are similar among patients who received hearts with donor pH between 7.0 and 7.8.
Table. Percent Recipient Survival by Donor pH during 36 Months Survivors