Utility of Preopeative Computed Tomography Scans for Predicting Long Term Outcomes after Surgical Aortic Valve Replacement

Background: Since 2016 we implemented the preparatory pathway for patients undergoing minimally invasive SAVR (mSAVR) in our institution with a contrast enhanced multidetector computed tomography (MDCT). We aimed to assess the utility of anatomical variables—as assessed by preoperative MDCT—in predicting the long-term outcomes after mSAVR.

Methods: We retrospectively analyzed all patients with preoperative MCDT and who underwent mSAVR through a J-sternotomy in our institution between June 2016 and Dec 2021. 136 variables (pre, intra and postoperative) has been evaluated as risk factors. A follow-up (FU) was conducted in all patients in December 2022. Kaplan–Meier curves were calculated for major cardiac events (MACCEs) and survival time. Furthermore, a logistic regression function and a cumulative hazard function were applied.

Results: 203 patients met the inclusion criteria (average age 70.22 ± 6.57 years, 40% female, log. Euroscore 7.47 ± 7.87%, Euroscore II 1.88 ± 1.25%). In hospital mortality was 1.48% (n = 3), while 10 patients (4.9%) died at follow-up. Median survival time was then 5.22 years. Univariate analysis showed that 13 variables were correlated with survival at FU: preoperative serum creatinine (hazard ratio [HR] 5.5, 95% confidence interval [CI] 1.18-25.67; p = 0.03), preoperative ischemic cardiomyopathy (HR 0.25, 95% CI 0.06–0.95, p = 0.04); distance annulus-left coronary artery (HR1.30, 95% CI1.08–1.57, p = 0.01), postoperative ischemic stroke (HR 0.0017, 95% CI 0.0003–0.0090, p < 0.001), life-threatening bleeding (HR 0.15, 95% CI 0.03–0.69, p = 0.02) and postoperative serum creatinine (HR 5.76, 95% CI 2.60–12.77, p < 0.001). The incidence of MACCEs at follow-up was 6.4%. Mean Free-from-MACCEs was 4.9 ± 0.19 [95% CI = 4.6–5.3] years. The variables BMI (HR 0.86, 95% CI 0.74–0.99, p = 0.05), preoperative Pmean (HR 1.05, 95% CI 1.01–1.09, p = 0.01), calcium load (HR 1.0006, 95% CI 1.00001–1.00117, p = 0.05), total calcium AV (HR 1.0006, 95% CI 1.000–1.001, p = 0.05), noncoronary cusp calcium load (HR 1. 002, 95% CI 1.0003–1.0038, p = 0.02) and new onset of delayed conduction (HR 0.29, 95% CI 0.08–0.99, p = 0.05) had an impact on MACCEs.

Conclusion: Our study shows the association of MDCT-derivated variables with the survival and MACCEs at FU following a mSAVR. The preoperative MDCT should therefore be included in the preparatory pathway of patients with severe aortic valve disease.

Publikationsverlauf

Artikel online veröffentlicht:
13. Februar 2024