Podpalov V.V.*, Sevrukevich V.I.*, Deev A.D., Ostrovsky Y.P.*
A method of the 5-year survival prognosing in patients with severe aortic stenosis
*Scientific and Practical center of Cardiology, Belarus
**Federal State Institution "National Research Center for Preventive Medicine" of the Ministry of Healthcare of the Russian Federation, Russian Federation
Objectives. To work out a method of the five-year survival prognosing in patients with severe aortic stenosis (AS), complicated by atrioventricular valves insufficiency.
Material and methods. The prospective study was conducted. Among all patients admitted to the Centre during 2005-2007 there were 198 patients with severe AS and secondary mitral and tricuspid regurgitation. They were divided into 2 groups: the 1st group included 46 patients not operated for different reasons; the 2nd group consisted of 152 patients who had undergone aortic valve replacement in combination with atrioventricular valvuloplasty. The follow-up period lasted for 5 years.
Results. The average age of 198 patients was 59,16 years, the proportion of men - 67%. Postoperative lethality made up 0,7%. During 5 years there were 35 deaths (76,1%) in the 1st group of patients, and 28 persons (18,4%) died in the 2nd group. Out of estimated parameters those with the most significant value in the prognosis of the five-year survival were included in the final prognostic regression model: left ventricular myocardial mass (p=0,086), pulmonary artery systolic pressure (p=0,002), LVEF (p=0,018), aortic valve peak systolic pressure gradient (p=0,038), age (p=0,012), sex (p=0,189) and adjustment coefficients for the fact of operation records were also added (df=10; a2 Wald=103,7; р=0,0001). The model had sensitivity of 87,2% and specificity of 52%. The values of risk factors profiles (RFP) were grouped in deciles. Each decile got respective value of the five-year survival rate which decreased with the growth of RFP.
Conclusions. With the obtained prognostic model the five-year survival can be determined in patients with severe AS complicated by atrioventricular valves insufficiency by means of RFP calculating.
Key words: aortic stenosis, aortic valve replacement, prognostic model.
1. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E, Ravaud P, Vahanian A. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003 Jul;24(13):1231-43.
2. Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999 Jul;16(1):9-13.
3. Roques F, Nashef SA, Michel P, Gauducheau E, de Vincentiis C, Baudet E, Cortina J, David M, Faichney A, Gabrielle F, Gams E, Harjula A, Jones MT, Pintor PP, Salamon R, Thulin L. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg. 1999 Jun;15(6):816-22.
4. Yap CH, Reid C, Yii M, Rowland MA, Mohajeri M, Skillington PD, Seevanayagam S, Smith JA. Validation of the EuroSCORE model in Australia. Eur J Cardiothorac Surg. 2006 Apr;29(4):441-6.
5. Parolari A, Pesce LL, Trezzi M, Loardi C, Kassem S, Brambillasca C, Miguel B, Tremoli E, Biglioli P, Alamanni F. Performance of EuroSCORE in CABG and off-pump coronary artery bypass grafting: single institution experience and meta-analysis. Eur Heart J. 2009 Feb;30(3):297-304.
6. Lebreton G, Merle S, Inamo J, Hennequin JL, Sanchez B, Rilos Z, Roques F. Limitations in the inter-observer reliability of EuroSCORE: what should change in EuroSCORE II? Eur J Cardiothorac Surg. 2011 Dec;40(6):1304-8.
7. Basraon J, Chandrashekhar YS, John R, Agnihotri A, Kelly R, Ward H, Adabag S. Comparison of risk scores to estimate perioperative mortality in aortic valve replacement surgery. Ann Thorac Surg. 2011 Aug;92(2):535-40.
8. Shih HH, Kang PL, Pan JY, Wu TH, Wu CT, Lin CY, Lin YH, Chou WT. Performance of European system for cardiac operative risk evaluation in Veterans General Hospital Kaohsiung cardiac surgery. J Chin Med Assoc. 2011 Mar;74(3):115-20.
9. Wang C, Yao F, Han L, Zhu J, Xu ZY. Validation of the European system for cardiac operative risk evaluation (EuroSCORE) in Chinese heart valve surgery. J Heart Valve Dis. 2010 Jan;19(1):21-7.
10. Nashef SA, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, Lockowandt U. EuroSCORE II. Eur J Cardiothorac Surg. 2012 Apr;41(4):734-44.
11. Biancari F, Vasques F, Mikkola R, Martin M, Lahtinen J, Heikkinen J. Validation of EuroSCORE II in patients undergoing coronary artery bypass surgery. Ann Thorac Surg. 2012 Jun;93(6):1930-5.
12. Zhang GX, Wang C, Wang L, Lu FL, Li BL, Han L, Xu ZY. Validation of EuroSCORE II in Chinese patients undergoing heart valve surgery [Electronic resourse]. Heart Lung Circ. 2013 Aug;22(8):606-11. Mode of access: http://dx.doi.org/10.1016/j.hlc.2012.12.012.
13. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2012 Oct;33(19):2451-96.
14. Tribouilloy C, Lévy F, Rusinaru D, Guéret P, Petit-Eisenmann H, Baleynaud S, Jobic Y, Adams C, Lelong B, Pasquet A, Chauvel C, Metz D, Quéré JP, Monin JL. Outcome after aortic valve replacement for low-flow/low-gradient aortic stenosis without contractile reserve on dobutamine stress echocardiography. J Am Coll Cardiol. 2009 May;53(20):1865-73.