Toumpoulis Ioannis K, Chamogeorgakis Themistocles P, Angouras Dimitrios C, Swistel Daniel G, Anagnostopoulos Constantine E, Rokkas Chris K
Columbia University College of Physicians and Surgeons, St. Luke's-Roosevelt Hospital Center, Department of Cardiothoracic Surgery, New York, USA.
J Heart Valve Dis. 2008 Sep;17(5):548-56.
Patients with heart valve surgery may have a periprocedural mortality extending up to one year after surgery. The study aim was to determine independent predictors for in-hospital and long-term mortality after heart valve surgery.
A total of 1,376 consecutive patients who underwent isolated or combined heart valve surgery at a single institution was studied. Multivariate logistic regression analysis was used to determine independent predictors for in-hospital mortality. Long-term survival data (mean follow up 5.6 years) were obtained from the National Death Index. Multivariate Cox regression analysis was used to determine independent predictors for long-term mortality. All available preoperative, intraoperative and postoperative risk factors were included in these analyses.
The mean EuroSCORE was 6.2 +/- 3.7. There were 86 (6.3%) in-hospital and 550 (40.0%) late deaths. Eleven independent predictors were determined for in-hospital mortality, and 13 for long-term mortality. There were six common independent predictors (preoperative dialysis, total bypass time, intraoperative stroke, postoperative sepsis and/or endocarditis, renal and respiratory failure). Unique independent predictors for in-hospital mortality included intra-aortic balloon pump, preoperative endocarditis, intravenous use of nitroglycerine, bleeding requiring reoperation and gastrointestinal complications. The model for in-hospital mortality showed acceptable calibration (Lemeshow-Hosmer, p = 0.629) and excellent discriminatory ability (C statistic 0.88). Unique independent predictors for long-term mortality included age, ejection fraction, stroke prior to surgery, hemodynamic instability, chronic obstructive pulmonary disease and deep sternal wound infection.
Independent predictors were determined for early and long-term mortality after heart valve surgery. The prevention of postoperative complications may be a key element for increased early and long-term survival in these patients.
心脏瓣膜手术患者围手术期死亡率可能持续至术后一年。本研究旨在确定心脏瓣膜手术后院内及长期死亡率的独立预测因素。
对在单一机构接受单纯或联合心脏瓣膜手术的1376例连续患者进行研究。采用多因素逻辑回归分析确定院内死亡率的独立预测因素。长期生存数据（平均随访5.6年）来自国家死亡指数。采用多因素Cox回归分析确定长期死亡率的独立预测因素。这些分析纳入了所有可用的术前、术中和术后危险因素。
欧洲心脏手术风险评估系统（EuroSCORE）平均为6.2±3.7。有86例（6.3%）院内死亡和550例（40.0%）晚期死亡。确定了11个院内死亡率的独立预测因素和13个长期死亡率的独立预测因素。有6个共同的独立预测因素（术前透析、总体外循环时间、术中卒中、术后脓毒症和/或心内膜炎、肾和呼吸衰竭）。院内死亡率的独特独立预测因素包括主动脉内球囊反搏、术前心内膜炎、静脉使用硝酸甘油、需要再次手术的出血和胃肠道并发症。院内死亡率模型显示校准良好（Lemeshow-Hosmer检验，p = 0.629）且具有出色的区分能力（C统计量0.88）。长期死亡率的独特独立预测因素包括年龄、射血分数、术前卒中、血流动力学不稳定、慢性阻塞性肺疾病和深部胸骨伤口感染。
确定了心脏瓣膜手术后早期和长期死亡率的独立预测因素。预防术后并发症可能是提高这些患者早期和长期生存率的关键因素。
