Table 2:
Cox proportional hazard model of the reoperation and mortality outcomes of 1301 patients without exclusion criteria and with aortic dimensions ≥35 mm (for the AVR cohort) or 40 mm (for the AVR with ascending aortic aneurysm repair cohort) and the largest aortic dimension ≤59 mm
| Univariate analysis |
Multivariate aortic dimension-based analysis (n = 1301) |
|||||
|---|---|---|---|---|---|---|
| HR (95% CI) | P-value | Overall P-value | HR (95% CI) | P-value | Overall P-value | |
| Preoperative data | ||||||
| Age at AVR (years) | ||||||
| <50 | 1 | <0.0001 | 1 | <0.0001 | ||
| 50–59 | 2.45 (1.15–4.71) | 0.02 | 1.94 (0.90–4.18) | 0.09 | ||
| 60–69 | 4.20 (2.05–8.60) | <0.0001 | 2.62 (1.25–5.49) | 0.010 | ||
| 70–79 | 10.0 (4.95–20.4) | <0.0001 | 5.42 (2.55–11.5) | 0.0001 | ||
| ≥80 | 16.3 (7.33–36.4) | <0.0001 | 9.73 (4.18–22.6) | <0.0001 | ||
| Gender (female) | 1.04 (0.71–1.53) | 0.84 | ||||
| Race (Caucasian) | 0.99 (0.50–1.96) | 0.98 | ||||
| BMI >30 kg/m2 | 0.79 (0.52–1.15) | 0.22 | ||||
| Smoker past or current | 1.76 (1.27–2.43) | 0.0006 | ||||
| COPD | 3.02 (2.06–4.42) | <0.0001 | 2.40 (1.61–3.57) | 0.0002 | ||
| Diabetes (NIDDM or IDDM) | 1.86 (1.21–2.86) | 0.005 | ||||
| Hypertension | 0.41 (0.28–0.59) | <0.0001 | 0.72 (0.49–1.06) | 0.10 | ||
| Preoperative creatinine (mg/dl) | 1.39 (1.20–1.62) | <0.0001 | ||||
| Preoperative dialysis | 4.30 (1.37–13.5) | 0.013 | 6.31 (1.97–20.2) | 0.002 | ||
| Cancer | 2.80 (1.97–3.98) | <0.0001 | 1.71 (1.18–2.49) | 0.005 | ||
| Peripheral vascular disease | 1.67 (1.10–2.53) | 0.017 | 1.63 (1.06–2.52) | 0.027 | ||
| Medications | ||||||
| Beta-blocker | 0.56 (0.35–0.89) | 0.014 | ||||
| ACEI/ARB | 1.02 (0.57–1.85) | 0.94 | ||||
| Lipid lowering | 1.32 (0.93–1.87) | 0.12 | ||||
| Prior cardiac status | ||||||
| NYHA class (n = 600) | ||||||
| I or II | 1 | 0.002 | ||||
| III | 2.16 (1.29–3.76) | 0.003 | ||||
| IV | 3.13 (1.37–7.14) | 0.007 | ||||
| Heart failure | 2.81 (1.97–4.02) | <0.0001 | 1.90 (1.30–2.76) | 0.0008 | ||
| Prior CABG or non-aortic valve surgery | 2.73 (1.58–4.74) | 0.0003 | ||||
| Prior MI | 3.03 (2.02–4.54) | <0.0001 | ||||
| Prior CVA | 1.06 (0.52–2.16) | 0.87 | ||||
| Coronary and valve disease | ||||||
| Coronary artery disease | 2.44 (1.76–3.38) | <0.0001 | ||||
| Aortic insufficiency | ||||||
| None, trace or mild | 1 | 0.0017 | ||||
| Moderate | 0.81 (0.55–1.21) | 0.30 | ||||
| Severe | 0.38 (0.21–0.71) | 0.002 | ||||
| Aortic valve area (cm2) | 1.00 (0.99–1.01) | 0.99 | ||||
| Mitral incompetence | ||||||
| None, trace or mild | 1 | 0.0005 | ||||
| Moderate | 2.13 (1.40–3.24) | 0.0004 | ||||
| Severe | 2.38 (1.25–4.54) | 0.007 | ||||
| LV ejection fraction (%) | ||||||
| <30 | 3.54 (2.17–5.77) | <0.0001 | <0.0001 | |||
| 30–49 | 2.11 (1.37–3.24) | 0.0007 | ||||
| ≥50 | 1 | |||||
| Aortic measurements | ||||||
| Largest aortic dimension (mm) | ||||||
| 35–39 | 1 | 0.40 | 1 | 0.23 | ||
| 40–44 | 0.69 (0.44–1.08) | 0.10 | 0.82 (0.51–1.31) | 0.40 | ||
| 45–49 | 0.86 (0.57–1.32) | 0.49 | 1.25 (0.73–2.16) | 0.42 | ||
| ≥50 | 0.77 (0.49–1.21) | 0.25 | 1.46 (0.80–2.67) | 0.22 | ||
| Largest aortic Z-score | ||||||
| <1.96 | 1 | 0.18 | ||||
| 1.96–2.99 | 0.74 (0.48–1.15) | 0.19 | ||||
| ≥3.0 | 0.70 (0.48–1.01) | 0.054 | ||||
| Operation | ||||||
| Hospital | ||||||
| BWH | 1 | |||||
| MGH | 1.12 (0.80–1.58) | 0.50 | ||||
| Year of operation | ||||||
| 2002–03 | 1 | 0.10 | ||||
| 2004–05 | 1.71 (0.93–3.15) | 0.086 | ||||
| 2006–07 | 1.56 (0.85–2.84) | 0.15 | ||||
| 2008–09 | 1.04 (0.54–2.00) | 0.91 | ||||
| 2010–11 | 1.15 (0.58–2.29) | 0.69 | ||||
| 2012–14 | 0.71 (0.31–1.65) | 0.43 | ||||
| Urgency | ||||||
| Elective | 1 | |||||
| Urgent or more | 2.23 (1.57–3.15) | <0.0001 | ||||
| CABG performed | 3.08 (2.23–4.26) | <0.0001 | 1.92 (1.36–2.71) | 0.0002 | ||
| DHCA used | 1.10 (0.77–1.57) | 0.59 | ||||
| Operation | ||||||
| AVR only | 1 | 1 | ||||
| AVR and Asc Ao | 0.76 (0.55–1.05) | 0.099 | 0.84 (0.52–1.35) | 0.47 | ||
| Aortic valve implant type | ||||||
| Mechanical | 1 | |||||
| Bioprosthesis | 2.22 (1.38–3.57) | 0.001 | ||||
| Mitral valve repair or replacement | 1.86 (1.05–3.28) | 0.033 | ||||
ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor blockers; Asc Ao: ascending aorta; 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; CVA: cardiovascular accident; DHCA: deep hypothermic circulatory arrest; HR: hazard ratio; IDDM: insulin-dependent diabetes mellitus; LV: left ventricular; MI: myocardial infarction; MGH: Massachusetts General Hospital; NIDDM: non-insulin-dependent diabetes mellitus; NYHA: New York Heart Association.