05. tbl. 105. árg. 2019

Early outcome of surgical aortic valve replacement for aortic stenosis in Icelandic females

Snemmkominn árangur opinna ósæðarlokuskipta við ósæðarlokuþrengslum hjá konum á Íslandi

Introduction: Aortic valve replacement (AVR) for aortic stenosis (AS) is the second most common open-heart procedure performed in Iceland. The aim of this study was to analyze the early outcome of AVR among females in Iceland.

Materials and methods: This was a retrospective study including 428 patients who underwent surgical AVR due to AS in Iceland from 2002-2013. Information was gathered from medical records, including pre- and postoperative results of echocardiography and complications. Overall survival was estimated (Kaplan-Meier) and logistic regression used to identify predictors of operative mortality. The median follow-up time was 8.8 years (0-16.5 years).

Results: Of the 428 patients, 151 were female (35.3%), that were on average 2 years older than men (72.6 ± 9.4 vs. 70.4 ± 9.8 yrs., p=0.020). Preoperative symptoms were similar, but women had significantly higher EurosSCORE II than men (5.2 ± 8.8 vs. 3.2 ± 4.6, p=0.002). Maximal pressure-gradient across the aortic valve was higher for women (74.4 ± 29.3 mmHg vs. 68.0 ± 23.4 mmHg, p=0,013) but postoperative complications, operative mortality (8.6% vs. 4.0%, p=0.068) and 5-year survival (78.6% vs. 83.1%, p=0.245) were comparable for women and men. Logistic regression analysis showed that female gender was not an independent predictor of 30-day mortality (OR 1.54, 95% CI 0.63-3.77).

Conclusions: Females constitute one third of patients that undergo AVR for AS in Iceland. At the time of surgery females are two years older than men and appear to have a more significant aortic stenosis at the time of surgery. However, complication rates, operative mortality and long-term survival were comparable for both genders.

Table I . Comparison of patient characteristics preoperatively. Results are given as number (%) or mean +/- standard deviation if normally distributed but as median (lowest-highest) if not.

Table II . Comparison of intraoperative data. Results are given as number (%) or mean +/- standard deviation if normally distributed but as median (lowest-highest) if not.

Table III . Comparison of postoperative complications and other factor related to the surgery. Results are given as number (%) or mean +/- standard deviation if normally distributed but as median (lowest-highest) if not.

Table IV . Independent predictors of operative mortality in a logistic regression model.

Figure I . Survival analysis (Kaplan-meier) of patients after aortic valve replacement.









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