MP12. Concomitant thoracic aorta replacement and mitral valve surgery outcomes and mortality predictors – a national level analysis
Presented During: Moderated E-Posters
University of Miami Hospital
Miami, FL
United States - Contact Me
Dr. Ahmed Alnajar is a clinical researcher who works in the Division of Cardiothoracic surgery within the Department of Surgery in the University of Miami. His research is focused on valve replacement and repair, public health related health, and social determinants of health. Previously, he led and participated in many research projects related to heart and lung transplantation. He wrote in multiple medical books and serves as a reviewer for scientific scholarly journals of the field of cardiology and cardiac surgery.
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
Title
Concomitant thoracic aorta replacement and mitral valve surgery outcomes and mortality predictors – a national level analysis
Objective
Recent studies demonstrate that a small but important minority of patients are presenting with both aortic pathology and concomitant mitral valve diseases, but the results are confined to select centers spanning from different non-representative time eras. Concomitant aorta and aortic valve surgery have been studied considerably, but the mitral valve is less so. This study was undertaken to examine the national outcomes of mortality and morbidity in patients who required combined thoracic aortic replacement with mitral valve surgery (MVR+Ao) from 2017-2020.
Methods:
We studied the outcomes of adults (18+ years) who received MVR+Ao using the National Inpatient Sample (2017-2020). For comparison, we used isolated Aortic surgery (Ao) and isolated mitral valve (MVR) patients from the same period. We compared the outcomes and analyzed factors associated with mortality with a multivariable analysis, adjusted by age, sex, surgery year, bicuspid aortic valve, mitral replacement, primary insurance, teaching hospital status, and the number of comorbidities.
Results
From 2017 to 2020, 565 patients underwent MVR+Ao. When compared to Ao and MVR patients, MVR+Ao patients group had fewer females (33%) and a higher Elixhauser comorbidity score. The mortality rate was 1.8%. There was no difference in mortality, wound, or valve complications between the groups. However, MVR+Ao patients had higher complication rates including bleeding (61%, p=0.005), acute renal failure (20%, p=0.039), pneumothorax, and respiratory failure. Additionally, the length of stay (8.7 days) and hospitalization cost ($55,469 per patient) were higher than other groups. Factors associated with higher mortality include females (OR: 1.32, CI: 1.01-1.73), mitral replacement (OR: 3.47, CI: 2.43-4.96), and higher Elixhauser score (OR: 1.12, CI: 1.10-1.14).
Conclusions
In patients with both the thoracic aorta and mitral pathology, the incidence of concomitant aortic and mitral surgery has remained relatively stable over the past few years. Consideration of mitral repair over mitral replacement may be pertinent when concomitant surgery is necessary. Future studies may consider investigating the reason for the significantly increased female disparities in this cohort.
Concomitant thoracic aorta replacement and mitral valve surgery outcomes and mortality predictors – a national level analysis
Objective
Recent studies demonstrate that a small but important minority of patients are presenting with both aortic pathology and concomitant mitral valve diseases, but the results are confined to select centers spanning from different non-representative time eras. Concomitant aorta and aortic valve surgery have been studied considerably, but the mitral valve is less so. This study was undertaken to examine the national outcomes of mortality and morbidity in patients who required combined thoracic aortic replacement with mitral valve surgery (MVR+Ao) from 2017-2020.
Methods:
We studied the outcomes of adults (18+ years) who received MVR+Ao using the National Inpatient Sample (2017-2020). For comparison, we used isolated Aortic surgery (Ao) and isolated mitral valve (MVR) patients from the same period. We compared the outcomes and analyzed factors associated with mortality with a multivariable analysis, adjusted by age, sex, surgery year, bicuspid aortic valve, mitral replacement, primary insurance, teaching hospital status, and the number of comorbidities.
Results
From 2017 to 2020, 565 patients underwent MVR+Ao. When compared to Ao and MVR patients, MVR+Ao patients group had fewer females (33%) and a higher Elixhauser comorbidity score. The mortality rate was 1.8%. There was no difference in mortality, wound, or valve complications between the groups. However, MVR+Ao patients had higher complication rates including bleeding (61%, p=0.005), acute renal failure (20%, p=0.039), pneumothorax, and respiratory failure. Additionally, the length of stay (8.7 days) and hospitalization cost ($55,469 per patient) were higher than other groups. Factors associated with higher mortality include females (OR: 1.32, CI: 1.01-1.73), mitral replacement (OR: 3.47, CI: 2.43-4.96), and higher Elixhauser score (OR: 1.12, CI: 1.10-1.14).
Conclusions
In patients with both the thoracic aorta and mitral pathology, the incidence of concomitant aortic and mitral surgery has remained relatively stable over the past few years. Consideration of mitral repair over mitral replacement may be pertinent when concomitant surgery is necessary. Future studies may consider investigating the reason for the significantly increased female disparities in this cohort.