They Do Not Die Early, They Die Later: Early and 1-Year Mortality after Aortic Valve Replacement

Objectives: Aortic valves are still widely implanted. The patients, however, become older and sicker as shown by our nationwide registry. In this registry, early mortality (EM) is shown to remain reasonably low making us believe that surgery still has its place. However, what happens with the patients after one year? Are they still alive?

Methods: Between 2011 and 2019, a total of 1,034 patients (67.1% male, mean: 69.8 years; 32.9% female, mean: 72.2 years), were enrolled receiving widely used stented biological valves with or without concomitant CABG, atrial ablation, left atrial appendage closure, or wrapping of the ascending aorta. Double or triple valve procedures as well as concomitant prosthetic aortic procedures were excluded. 105 patients were identified presenting with endocarditis. Odds ratios (OR) for the early mortality were calculated regarding comorbidities as potential risk factors. Statistical analysis was performed using SPSS.

Result: Overall EM was 6.1% while 1-year mortality was 11.2%. In contrast, EM for elective patients was 1.6% and 1-year mortality was 5.8%. Incidence of EM was significantly increased following decompensation (OR: 3.28; p < 0.001), preexisting prosthetic valve (OR: 11.27; p < 0.001), pacemaker carrier (OR: 3.77; p = 0.001); dialysis (OR: 16.39; p = 0.001), and pHT 56–60 mm Hg (OR: 7.25; p = 0,006). Postoperative complications such as SIRS (OR: 58.73; p < 0.001), sepsis (OR: 104.58; p < 0.001), multiorgan failure (OR: 3395.00; p < 0.001), ECMO (OR: 112.40; p < 0.001), hepatic failure (OR: 100.83; p < 0.001), dialysis (OR: 41.02; p < 0.001), gastrointestinal bleeding (OR: 51.00; p < 0.001), and ileus affording surgery (OR: 48.50; p = 0.001) also increased the mortality.

Conclusion: The reasonably low early mortality does unfortunately not reflect the situation after one year. 11% of our patients had deceased at that time indicating that comorbidities and age take their toll. In contrast, elective patients fortunately fare quite well pointing toward early diagnostics and transferal as well as optimization of medication prior to surgery. The same is true for several typical risk factors influencing the odds markedly. These patients require utmost preoperative care and thorough indication for surgery or alternative measures such as TAVI.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021