MP70. The Impact of Comorbidities on Outcomes of Concomitant Mitral Valve Intervention with Ascending Aortic Aneurysm Surgery
New York Presbyterian Hospital
New York, NY
United States - Contact Me
· Assistant Professor, Cardiothoracic Surgery Department, Weill Cornell Medical College/New York Presbyterian Hospital, Cornell University, New York, NY, USA
· Surgical Oncology Department, National Cancer Institute (NCI), Cairo University,Egypt
Research Interests:A) Cardiothoracic Surgery especially esophageal cancer, lung cancer and mesothelioma in addition to coronary artery bypass graft, radial artery harvest and cardiac tumors. I am interested in minimally invasive surgery in general and B)Statistics especially meta-analysis randomized clinical trials and large databases analysis.
Professional Memberships:
· Member of Intercollegiate Royal College of Surgeons (IMRCS)
· Membership of Journal of Thoracic Oncology
· Membership of American Association for Thoracic Surgery
· Membership of American Thoracic Society
Contributions:
I published over 250 articles, and I am an editor in 8 journals (especially deputy statistical editor in The Journal of Thoracic and Cardiovascular Surgery, Associate Editor in Frontier in Oncology and Associate Editor in BMC Cardiovascular disorders in addition to Annals of Surgical Oncology and Vessel Plus) and reviewers in more than 30 journals with particular interest in Minimally Invasive Cardiothoracic Surgery (including tumors of heart, lung, thymus, esophagus in addition to minimally invasive coronary artery bypass graft and mitral surgery). I am also interested in conducting meta-analyses in different Cardiothoracic Surgery and Oncology fields. Currently I am editing a book about Thoracic Malignancies: A Deep Insight in addition to many ongoing meta-analyses and meta-analysis of prior meta-analyses.
Webpages: Weill Cornell Webpage (https://vivo.weill.cornell.edu/display/cwid-mmr2011)
Description
Methods: Patients undergoing concomitant mitral valve intervention and aneurysm surgery between 1997 and 2022 were reviewed. Age-adjusted CCI scores were calculated based on clinical status at the time of index operation. Primary endpoint was all cause mortality. Secondary endpoints were a composite of major adverse events (MAE), including operative mortality, dialysis, myocardial infarction and stroke, and incidence of individual major complications. Chi-square test, Logistic and Cox regression analysis, and Kaplan-Meier estimates were used. Maximally selected rank statistics (MSRS) were used to identify the best cutoff of CCI to predict late mortality.
Results: Out of 3853 ascending aneurysm repairs, 186 (4.8%) patients (median age 65 [interquartile range (IQR): 54-76] and 69% males) had concomitant mitral valve intervention. Median CCI was 4 [IQR: 3-6]. MSRS identified a cutoff for CCI of 5, which had the highest significant survival difference. Perioperative MAE was higher in CCI>5 (11.0% vs 2.1%, P=0.017), and postoperative need for tracheostomy and CVA had a trend to be higher in CCI>5 (P=0.055). On multivariable Cox regression analysis, higher CCI (HR= 1.61 [95%CI 1.24;2.10], P=<0.001) was associated with late mortality and recent era (Year 2010 and after (HR= 0.18 [95%CI 0.03;0.95], P=0.0431)) was protective. Logistic regression revealed that higher CCI, as a continuous variable, was associated with higher odds of MAE, postoperative dialysis and need for tracheostomy (Table 1). Five- and ten-year overall survival were 95.9% and 67.1% vs 59.7% and 19.9%, respectively, in CCI≤5 vs CCI>5 (P<0.001).
Conclusions: CCI can be a helpful tool in predicting outcomes of patients undergoing concomitant mitral valve intervention with ascending aortic surgery. A high CCI score is associated with worse operative outcomes and decreased long-term survival.