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J Thorac Cardiovasc Surg. 2014 Sep;148(3):973-9; discussion 979-80. doi: 10.1016/j.jtcvs.2014.06.015. Epub 2014 Jun 13.

When does transapical aortic valve replacement become a futile procedure? An analysis from a national registry.

Author information

  • 1Division of Cardiac Surgery, University of Padova, Padova, Italy. Electronic address: adonofrio@hotmail.it.
  • 2Division of Cardiac Surgery, University of Torino, Torino, Italy.
  • 3Division of Cardiac Surgery, Monzino Hospital, Milano, Italy.
  • 4Division of Cardiac Surgery, Clinica Montevergine, Mercogliano, Italy.
  • 5Department of Cardiac Surgery, San Camillo Hospital, Roma, Italy.
  • 6Division of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo and Rozzano, Italy.
  • 7Division of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy.
  • 8Division of Cardiac Surgery, University of Pavia, Pavia, Italy.
  • 9Division of Cardiac Surgery, Policlinico S. Orsola Malpighi, Bologna, Italy.
  • 10Division of Cardiac Surgery, Clinica S. Maria, Bari, Italy.
  • 11Ospedale del Cuore, Fondazione Monastiero, Massa, Italy.
  • 12Division of Cardiac Surgery, Ordine Mauriziano Hospital, Torino, Italy.
  • 13San Raffaele University Hospital, Milano, Italy.
  • 14Cardiac Surgery, Hesperia Hospital, Modena, Italy.
  • 15Division of Cardiac Surgery, Ospedale dell'Angelo, Mestre, Italy.
  • 16Division of Cardiac Surgery, University of Parma, Parma, Italy.
  • 17Division of Cardiac Surgery, S. Maria della Misericordia Hospital, Udine, Italy.
  • 18Division of Cardiac Surgery, S. Croce e Carle Hospital, Cuneo, Italy.
  • 19Division of Cardiac Surgery, Azienda Ospedaliera-Universitaria, Trieste, Italy.
  • 20Cardiovascular Surgery, University of Verona, Verona, Italy.
  • 21Division of Cardiac Surgery, University of Padova, Padova, Italy.

Abstract

OBJECTIVES:

Patient selection is crucial to achieve good outcomes and to avoid futile procedures in patients undergoing transcatheter aortic valve replacement. The aim of this multicenter retrospective study was to identify independent predictors of 1-year mortality in patients surviving after transapical transcatheter aortic valve replacement.

METHODS:

We analyzed data from the Italian registry of transapical transcatheter aortic valve replacement that includes patients undergoing operation in 21 centers from 2007 to 2012. Futility was defined as mortality within 1 year after transapical transcatheter aortic valve replacement in patients surviving at 30 days. Thirty-day survivors were divided in 2 groups: futility (group F) and nonfutility (group NF). Cox proportional hazard regression analysis was performed to identify independent predictors of futility.

RESULTS:

We analyzed data from 645 patients with survival of 30 days or more after transapical transcatheter aortic valve replacement. Groups F and NF included 60 patients (10.8%) and 585 patients (89.2%), respectively. Patients in group F were more likely to have insulin-dependent diabetes (15% vs 7.2%, P = .03), creatinine 2.0 mg/dL or greater or dialysis (18.3% vs 8.2%, P = .01), logistic European System for Cardiac Operative Risk Evaluation greater than 20% (66.7% vs 50.3%, P = .02), preoperative rhythm disorders (40% vs 25.3%, P = .03), critical preoperative state (8.3% vs 1.8%, P = .002), and left ventricular ejection fraction less than 30% (15% vs 2.9%, P < .001). The multivariate analysis identified the following as independent predictors of futility: insulin-dependent diabetes (odds ratio, 3.1; P = .003), creatinine 2.0 mg/dL or greater or dialysis (odds ratio, 2.52; P = .012), preoperative rhythm disorders (odds ratio, 1.88; P = .04), and left ventricular ejection fraction less than 30% (odds ratio, 4.34; P = .001).

CONCLUSIONS:

According to our data, among patients undergoing transapical transcatheter aortic valve replacement, those with insulin-dependent diabetes, advanced chronic kidney disease, rhythm disorders, and low left ventricular ejection fraction have a higher risk to undergo futile procedures.

Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

[PubMed - indexed for MEDLINE]
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