Exploration of Cardiology

Table 10. Cox regression for long-term mortality

Variable	Unmatched				Matched
Variable	HR	95% CI lower	95% CI upper	P value	HR	95% CI lower	95% CI upper	P value
Age	1.036	1.017	1.056	< 0.001	1.052	1.025	1.079	< 0.001
Female gender	1.904	1.221	2.970	0.005	1.601	0.875	2.929	0.127
BMI	0.982	0.944	1.022	0.375	0.951	0.898	1.007	0.082
NYHA classification	0.824	0.657	1.033	0.094	0.848	0.627	1.145	0.281
HF	1.148	0.901	1.462	0.264	1.233	0.841	1.809	0.283
Previous cardiac surgery	1.607	0.954	2.705	0.074	2.095	1.029	4.266	0.042
Diabetes	0.929	0.437	1.973	0.847	1.498	0.602	3.725	0.385
Hypertension	1.009	0.619	1.644	0.972	0.966	0.469	1.992	0.926
Smoking	1.074	0.788	1.462	0.652	1.319	0.887	1.961	0.172
Renal disease	0.835	0.604	1.155	0.276	0.880	0.569	1.359	0.564
COPD	1.183	0.632	2.214	0.600	1.380	0.588	3.236	0.459
History of TIA/CVA	0.751	0.528	1.069	0.112	0.662	0.207	2.112	0.486
PAD	1.437	0.845	2.442	0.181	1.145	0.514	2.549	0.741
Preoperative AF	1.525	0.817	2.847	0.185	1.807	0.774	4.221	0.171
Extent of CAD	1.275	0.961	1.691	0.093	1.198	0.770	1.862	0.423
LMS involvement	0.348	0.093	1.297	0.116	0.191	0.023	1.581	0.125
LVEF	1.065	0.751	1.509	0.725	0.814	0.464	1.427	0.473
AS	0.553	0.330	0.927	0.024	0.444	0.207	0.952	0.037
AR	3.666	2.297	5.851	< 0.001	3.961	2.189	7.166	< 0.001
Cardiogenic shock	2.150	0.874	5.290	0.096	0.859	0.209	3.526	0.833
Preoperative inotropes	3.523	1.441	8.610	0.006	2.002	0.380	10.561	0.413
Preoperative intubation	0.419	0.147	1.193	0.103	1.052	0.187	5.928	0.954
Operative urgency	1.298	0.951	1.772	0.101	1.325	0.865	2.028	0.196
CPB time	1.008	1.005	1.011	< 0.001	1.009	1.005	1.013	< 0.001
ACX time	0.998	0.996	0.999	0.013	0.999	0.997	1.001	0.173
Circulatory arrest time	0.999	0.985	1.013	0.904	0.998	0.979	1.017	0.805
Homograft	0.230	0.032	1.653	0.144	0.488	0.234	1.015	0.055
Biological CVG	0.293	0.039	2.176	0.230	0.939	0.437	2.015	0.871
Mechanical CVG	0.263	0.036	1.922	0.188	-	-	-	-
Etiology-dissection	0.841	0.376	1.881	0.673	1.057	0.357	3.134	0.920
Etiology-aneurysm	0.804	0.464	1.396	0.439	0.851	0.367	1.971	0.706
Etiology-native valve IE	1.330	0.581	3.046	0.500	1.685	0.503	5.644	0.398
Etiology-prosthetic valve IE	0.746	0.266	2.089	0.577	0.727	0.132	4.019	0.715
Postoperative low CO	0.681	0.442	1.051	0.083	0.825	0.460	1.478	0.517
Re-intubation	2.538	1.068	6.029	0.035	3.173	1.033	9.746	0.044
Tracheostomy	0.614	0.221	1.702	0.348	0.623	0.159	2.434	0.496
Postoperative CVA	2.104	0.632	7.002	0.225	1.608	0.600	4.315	0.345
Post-op AF	0.777	0.474	1.275	0.319	0.835	0.431	1.619	0.594
Post-op CHB	0.780	0.295	2.061	0.616	0.691	0.104	4.570	0.701
Postoperative sepsis	0.986	0.708	1.375	0.935	0.427	0.088	2.084	0.293
DSWI	3.687	1.605	8.471	0.002	21.131	1.091	409.111	0.044
Postoperative RRT	0.637	0.303	1.337	0.233	0.513	0.188	1.397	0.191
Permanent dialysis	1.246	0.513	3.025	0.627	0.769	0.212	2.792	0.690
Postoperative ischaemic bowel disease	7.184	1.892	27.269	0.004	36.975	4.654	293.770	< 0.001
Postoperative MOF	8.279	3.619	18.939	< 0.001	11.772	3.268	42.403	< 0.001
Postoperative hospital stay	0.966	0.950	0.984	< 0.001	0.963	0.935	0.992	0.013

Return to article view

ACX: aortic ceoss clamp; AF: atrial fibrillation; AR: aortic regurgitation; AS: aortic stenosis; BMI: body mass index; CAD: coronary artery disease; CHB: complete heart block; CI: confidence interval; CO: cardiac output; COPD: chronic obstructive pulmonary disease; CPB: cardiopulmonary bypass; CVA: cerebrovascular accident; CVG: composite valve graft; DSWI: deep sternal wound infection; HF: heart failure; HR: hazard ratio; IE: infective endocarditis; LMS: left main stem; LVEF: left ventricular ejection fraction; MOF: multi otgan failure; NYHA: New York Heart Association; PAD: peripheral arterial disease; RRT: renal replacement therapy; TIA: transient ischaemic attack

Declarations

Acknowledgments

The authors acknowledge the support of Siobhan Daley and Andy Ryan from Department of Quality & Safety, Harefield Hospital. Abstract presented at the EACTS 38th Annual Meeting, Lisbon, Portugal, 9–12 October 2024.

Author contributions

MC: Conceptualization, Formal analysis, Writing—original draft. MYS: Investigation. FDR, TB, SKB, and JAG: Writing—review & editing. SGR: Conceptualization, Data curation, Writing—original draft, Writing—review & editing. All authors read and approved the submitted version.

Conflicts of interest

The authors declare that there are no conflicts of interest.

Ethical approval

The study was approved by the Harefield Hospital ethics committee (Q&S 15/02/2024) and complies with the Declaration of Helsinki.

Consent to participate

Informed consent to participate in the study was waived by the Harefield Hospital ethics committee due to the retrospective nature of the study.

Consent to publication

Not applicable.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available due to General Data Protection Regulation (GDPR) but are available from the senior author on reasonable request (SGR, Email: drrajashahzad@hotmail.com).

Funding

Not applicable.

Copyright

Publisher’s note

Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.

References

Sá MP, Tasoudis P, Jacquemyn X, Van den Eynde J, Caranasos TG, Ikonomidis JS, et al. Long-Term Outcomes of Patients Undergoing Aortic Root Replacement With Mechanical Versus Bioprosthetic Valves: Meta-Analysis of Reconstructed Time-to-Event Data. J Am Heart Assoc. 2023;12:e030629. [DOI] [PubMed] [PMC]

Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143:e72–227. Erratum in: Circulation. 2021;143:e229. Erratum in: Circulation. 2023;148:e8. Erratum in: Circulation. 2023;148:e185. Erratum in: Circulation. 2024;150:e267. [PubMed]

Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al.; ESC/EACTS Scientific Document Group. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2022;43:561–632. Erratum in: Eur Heart J. 2022;43:2022. [DOI] [PubMed]

Melina G, Robertis FD, Gaer JAR, Amrani M, Khaghani A, Yacoub MH. Mid-term pattern of survival, hemodynamic performance and rate of complications after medtronic freestyle versus homograft full aortic root replacement: results from a prospective randomized trial. J Heart Valve Dis. 2004;13:972–6. [PubMed]

Nötzold A, Gerriets T, Eggers J, Kupiske G, Seidel G, Kaps M, et al. Circulating microemboli after composite replacement or valve-sparing aortic root surgery. Thorac Cardiovasc Surg. 2002;50:141–4. [DOI] [PubMed]

Gottesman RF, McKhann GM, Hogue CW. Neurological complications of cardiac surgery. Semin Neurol. 2008;28:703–15. [DOI] [PubMed] [PMC]

Enayati M, Eilenberg M, Grasl C, Riedl P, Kaun C, Messner B, et al. Biocompatibility Assessment of a New Biodegradable Vascular Graft via In Vitro Co-culture Approaches and In Vivo Model. Ann Biomed Eng. 2016;44:3319–34. [DOI] [PubMed] [PMC]

Arsalan M, Walther T. Durability of prostheses for transcatheter aortic valve implantation. Nat Rev Cardiol. 2016;13:360–7. [DOI] [PubMed]

Goldstone AB, Chiu P, Baiocchi M, Lingala B, Patrick WL, Fischbein MP, et al. Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement. N Engl J Med. 2017;377:1847–57. [DOI] [PubMed] [PMC]

10.

Mookhoek A, Korteland NM, Arabkhani B, Centa ID, Lansac E, Bekkers JA, et al. Bentall Procedure: A Systematic Review and Meta-Analysis. Ann Thorac Surg. 2016;101:1684–9. [DOI] [PubMed]

11.

Dunning J, Gao H, Chambers J, Moat N, Murphy G, Pagano D, et al. Aortic valve surgery: marked increases in volume and significant decreases in mechanical valve use—an analysis of 41,227 patients over 5 years from the Society for Cardiothoracic Surgery in Great Britain and Ireland National database. J Thorac Cardiovasc Surg. 2011;142:776–82.e3. [DOI] [PubMed]

12.

Chen C, Chen C, Chang F, Cheng Y, Wu VC, Lin C, et al. Mechanical Versus Bioprosthetic Aortic Valve Replacement in Patients Undergoing Bentall Procedure. J Am Heart Assoc. 2024;13:e030328. [DOI] [PubMed] [PMC]

13.

Melina G, Robertis FD, Gaer JA, Angeloni E, El-Hamamsy I, Bahrami T, et al. Long-term survival after xenograft versus homograft aortic root replacement: Results from a prospective randomized trial. J Thorac Cardiovasc Surg. 2021;161:57–65. [DOI] [PubMed]

14.

Ennker J, Albert A, Ennker IC. Stentless aortic valves. Current aspects. HSR Proc Intensive Care Cardiovasc Anesth. 2012;4:77–82. [PubMed] [PMC]

15.

Svensson LG, Pillai ST, Rajeswaran J, Desai MY, Griffin B, Grimm R, et al. Long-term survival, valve durability, and reoperation for 4 aortic root procedures combined with ascending aorta replacement. J Thorac Cardiovasc Surg. 2016;151:764–74.e4. [DOI] [PubMed] [PMC]

16.

Lund O, Chandrasekaran V, Grocott-Mason R, Elwidaa H, Mazhar R, Khaghani A, et al. Primary aortic valve replacement with allografts over twenty-five years: valve-related and procedure-related determinants of outcome. J Thorac Cardiovasc Surg. 1999;117:77–91. [DOI] [PubMed]

17.

Arabkhani B, Bekkers JA, Andrinopoulou E, Roos-Hesselink JW, Takkenberg JJM, Bogers AJJC. Allografts in aortic position: Insights from a 27-year, single-center prospective study. J Thorac Cardiovasc Surg. 2016;152:1572–9.e3. [DOI] [PubMed]

18.

Bekkers JA, Klieverik LMA, Raap GB, Takkenberg JJM, Bogers AJJC. Re-operations for aortic allograft root failure: experience from a 21-year single-center prospective follow-up study. Eur J Cardiothorac Surg. 2011;40:35–42. [DOI] [PubMed]

19.

Peterss S, Fabry TG, Steffen J, Orban M, Buech J, Radner C, et al. Aortic valved homograft degeneration: surgical or transcatheter approach for repeat aortic valve replacement? Eur J Cardiothorac Surg. 2024;66:ezae280. [DOI] [PubMed]

20.

Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al.; ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739-91. [DOI] [PubMed]

21.

Dumesnil JG, LeBlanc MH, Cartier PC, Métras J, Desaulniers D, Doyle DP, et al. Hemodynamic features of the freestyle aortic bioprosthesis compared with stented bioprosthesis. Ann Thorac Surg. 1998;66:S130–3. [DOI] [PubMed]

22.

Pibarot P, Dumesnil JG, Jobin J, Cartier P, Honos G, Durand LG. Hemodynamic and physical performance during maximal exercise in patients with an aortic bioprosthetic valve: Comparison of stentless versus stented bioprostheses. J Am Coll Cardiol. 1999;34:1609–17. [DOI] [PubMed]

23.

Fries R, Wendler O, Schieffer H, Schäfers HJ. Comparative rest and exercise hemodynamics of 23-mm stentless versus 23-mm stented aortic bioprostheses. Ann Thorac Surg. 2000;69:817–22. [DOI] [PubMed]

24.

Bach DS, Kon ND, Dumesnil JG, Sintek CF, Doty DB. Ten-year outcome after aortic valve replacement with the freestyle stentless bioprosthesis. Ann Thorac Surg. 2005;80:480–7. [DOI] [PubMed]

25.

Bach DS, Metras J, Doty JR, Yun KL, Dumesnil JG, Kon ND. Freedom from structural valve deterioration among patients aged < or = 60 years undergoing Freestyle stentless aortic valve replacement. J Heart Valve Dis. 2007;16:649–56. [PubMed]

26.

Mohammadi S, Tchana-Sato V, Kalavrouziotis D, Voisine P, Doyle D, Baillot R, et al. Long-term clinical and echocardiographic follow-up of the Freestyle stentless aortic bioprosthesis. Circulation. 2012;126:S198–204. [DOI] [PubMed]

27.

Bach DS, Kon ND. Long-term clinical outcomes 15 years after aortic valve replacement with the Freestyle stentless aortic bioprosthesis. Ann Thorac Surg. 2014;97:544–51. [DOI] [PubMed]

28.

Tavakoli R, Danial P, Oudjana AH, Jamshidi P, Gassmann M, Leprince P, et al. Biological aortic valve replacement: advantages and optimal indications of stentless compared to stented valve substitutes. A review. Gen Thorac Cardiovasc Surg. 2018;66:247–56. [DOI] [PubMed]