Table 1:
Demographic, medical and surgical characteristics and aortic dimensions of 1301 patients without exclusion criteria and with aortic dimensions ≥35 mm and <59 mm (for AVR cohort) or ≥ 40 mm (for AVR with ascending aortic aneurysm repair cohort) and the largest aortic dimension ≤59 mm
| AVR-only (n = 683) | AVR and AAA (n = 618) | P-value | |
|---|---|---|---|
| Preoperative data | |||
| Age at AVR (years), n (%) | |||
| <50 | 37 (6) | 45 (7) | <0.0001 |
| 50–59 | 81 (12) | 103 (16) | |
| 60–69 | 151 (22) | 155 (25) | |
| 70–79 | 225 (33) | 227 (37) | |
| ≥80 | 188 (28) | 88 (14) | |
| Gender (female), n (%) | 148 (22) | 151 (24) | 0.24 |
| Race (Caucasian), n (%) | 640 (94) | 596 (96) | 0.031 |
| BMI >30 kg/m2, n (%) | 208 (31) | 188 (30) | 0.98 |
| Smoker past or current, n (%) | 236 (35) | 193 (31) | 0.20 |
| COPD, n (%) | 84 (12) | 54 (9) | 0.035 |
| Diabetes (NIDDM or IDDM), n (%) | 111 (16) | 41 (7) | <0.0001 |
| Dyslipidaemia, n (%) | 454 (67) | 326 (53) | <0.0001 |
| Hypertension, n (%) | 412 (61) | 343 (56) | 0.039 |
| Preoperative creatinine, mean (SD) | 1.12 (0.61) | 1.04 (0.45) | 0.004 |
| Preoperative dialysis, n (%) | 5 (1) | 4 (1) | 0.85 |
| Cancer, n (%) | 108 (16) | 82 (13) | 0.19 |
| Prior stroke, n (%) | 45 (7) | 31 (5) | 0.22 |
| Peripheral vascular disease, n (%) | 48 (7) | 99 (16) | <0.0001 |
| Medications, n (%) | |||
| Beta-blocker | 245 (36) | 275 (44) | 0.006 |
| ACEI/ARB | 499 (73) | 397 (64) | 0.001 |
| Lipid lowering | 612 (89) | 570 (92) | 0.04 |
| Prior cardiac status | |||
| NYHA class, n (%) | |||
| I or II | 170 (59) | 213 (73) | 0.002 |
| III | 99 (34) | 66 (24) | |
| IV | 21 (7) | 14 (5) | |
| Heart failure, n (%) | 135 (20) | 91 (15) | 0.016 |
| Prior CABG surgery, n (%) | 29 (6) | 3 (1) | <0.0001 |
| Prior non-aortic valve surgery, n (%) | 14 (3) | 8 (2) | 0.39 |
| Coronary and valve disease | |||
| Coronary artery disease, n (%) | 342 (50) | 221 (36) | <0.0001 |
| Aortic insufficiency, n (%) | |||
| None, trace or mild | 452 (66) | 362 (59) | 0.0003 |
| Moderate | 121 (18) | 167 (27) | |
| Severe | 109 (16) | 89 (14) | |
| Aortic valve area (cm2), mean (SD) | 0.80 (0.30) | 0.92 (0.39) | <0.0001 |
| Mitral incompetence, n (%) | |||
| None, trace or mild | 567 (83) | 546 (88) | 0.020 |
| Moderate | 86 (13) | 50 (8) | |
| Severe | 29 (4) | 22 (4) | |
| LV ejection fraction (%), n (%) | |||
| <30 | 45 (7) | 14 (2) | 0.0003 |
| 30–49 | 75 (11) | 58 (10) | |
| ≥50 | 552 (82) | 557 (88) | |
| Aortic measurements (mm) | |||
| Aortic root dimension | |||
| Mean (SD)/n | 37.3 (5.3)/287 | 39.1 (6.4)/349 | 0.0001 |
| Median (10–90% CI) | 37 (31–44) | 39 (31–47) | 0.0006 |
| Sinotubular junction dimension | |||
| Mean (SD)/n | 32.7 (5.7)/394 | 36.4 (6.6)/361 | <0.0001 |
| Median (10–90% CI) | 32 (26–40) | 36 (29–46) | <0.0001 |
| Ascending aorta dimension | |||
| Mean (SD)/n | 39.7 (4.7)/557 | 47.3 (4.7)/603 | <0.0001 |
| Median (10–90% CI) | 39 (35–46) | 47 (42–53) | <0.0001 |
| Largest aortic dimension | |||
| Mean (SD)/n | 40.2 (4.2)/682 | 47.9 (4.1)/618 | <0.0001 |
| Median (10–90% CI) | 39 (35–46) | 48 (43–54) | <0.0001 |
| Operation | |||
| Hospital, n (%) | |||
| BWH | 245 (36) | 275 (45) | 0.002 |
| MGH | 437 (64) | 343 (55) | |
| Year of operation, n (%) | |||
| 2002–03 | 61 (9) | 35 (6) | <0.0001 |
| 2004–05 | 74 (11) | 68 (11) | |
| 2006–07 | 131 (19) | 88 (14) | |
| 2008–09 | 110 (16) | 153 (25) | |
| 2010–11 | 128 (19) | 146 (24) | |
| 2012–14 | 178 (26) | 128 (21) | |
| Urgency, n (%) | |||
| Elective | 551 (81) | 531 (86) | 0.013 |
| Non-elective | 131 (19) | 87 (14) | |
| CABG performed, n (%) | 158 (23) | 100 (16) | 0.002 |
| DHCA used, n (%) | 1 (0) | 339 (55) | <0.0001 |
| Aortic valve implant type, n (%) | |||
| Mechanical | 129 (21) | 143 (26) | 0.039 |
| Bioprosthesis | 489 (79) | 407 (74) | |
| Mitral valve repair or replacement, n (%) | 47 (7) | 20 (3) | 0.003 |
| Postoperative outcomes | |||
| Duration of follow-up (years), median (10–90% CI) | 6.5 (3.2–12.1) | 6.8 (3.4–11.4) | 0.68 |
| Operative mortality, n (%) | 5 (1) | 2 (0) | 1.00 |
| Death or aortic reoperation, n (%) | |||
| 1 year | 13/668 (1.9) | 16/602 (2.7) | 0.34 |
| 5 years | 36/445 (8.1) | 28/431 (6.5) | 0.33 |
| 10 years | 42/145 (29) | 23/110 (21) | 0.19 |
| Second operation type, n (%) | |||
| Aortic repair or replacement | 0 (0) | 4 (0) | 1.00 |
| AVR and aortic repair or replacement | 1 (0) | 4 (0) | |
AAA: ascending aortic aneurysm; ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor blockers; AVR: aortic valve replacement; BMI: body mass index; BWH: Brigham and Women’s Hospital; CABG: coronary artery bypass grafting; CI: confidence interval; COPD: chronic obstructive pulmonary disease; DHCA: deep hypothermic circulatory arrest; IDDM: insulin-dependent diabetes mellitus; LV: left ventricular; MGH: Massachusetts General Hospital; NIDDM: non-insulin-dependent diabetes mellitus; NYHA: New York Heart Association; SD: standard deviation.