Abstract 4283: Outcomes of Patients Undergoing Concomitant Aortic and Mitral Valve Surgery in Northern New England

Background : During the past 20 years (yrs), there has been a steady increase in concomitant aortic(AV) and mitral valve(MV) surgery in northern New England (NNE). We examined the in-hospital and long-term mortality for these patients by procedure, patient age and sex. Methods : This is a prospective, regional, cohort study of 1057 patients undergoing concomitant AV and MV surgery in NNE from 1989 through 2007. Long-term survival was obtained by linking our registry data to the Social Security Administration Death Master File. Kaplan-Meier and log-rank tests were performed. Results : Patient characteristics: age &lt;70 yrs (45.1%), 70–79 yrs (41.0%), and ≥ 80 yrs (13.9%); female sex (44.1%); associated CABG (46.9%); diabetes (19.5%); CHF (60.7%); PVD (17.7%); non dialysis renal failure (RF) (5.3%); dialysis dependant RF (2.4%). In-hospital mortality was 15.4% (11.0% for patients &lt;70 yrs, 18.0% for 70–79 year olds, and 24% for those ≥80). The median period of follow-up was 3.5 yrs. Overall median survival was 7.3 yrs. Median survival for surgery without CABG was 9.5 yrs and 5.7 yrs with CABG (p&lt;0.001). Survival among women was worse compared to men (7.3 v 9.3, yrs, p=0.033). Median survival by age group was 11.0 yrs for patients &lt;70, 5.4 yrs for 70-79 year olds, and 4.8 for ≥ 80. Median survival was not significantly different for patients ≥ 80 compared to those 70–79 yrs old (p=0.245). Conclusions : Double valve open heart surgery has a high in-hospital mortality rate. Long-term survival was decreased by having a concomitant CABG, being female and being 70 yrs or older. Although short-term mortality was higher, median survival for patients ≥ 80 yrs was equivalent to that for patients 70–79 yrs. </jats:p

Comparative effectiveness of coronary artery bypass grafting versus percutaneous coronary intervention in a real-world Surgical Treatment for Ischemic Heart Failure trial population.

OBJECTIVE: There are no prospective randomized trial data to guide decisions on optimal revascularization strategies for patients with multivessel coronary artery disease and reduced ejection fraction. In this analysis, we describe the comparative effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in this patient population. METHODS: A multicenter, retrospective analysis of all CABG (n = 18,292) and PCIs (n = 55,438) performed from 2004 to 2014 among 7 medical centers reporting to the Northern New England Cardiovascular Disease Study Group. After applying inclusion and exclusion criteria from the Surgical Treatment for Ischemic Heart Failure trial, there were 955 CABG and 718 PCI patients with an ejection fraction ≤ 35% and 2- or 3-vessel disease. Inverse probability weighting was used for risk adjustment. The primary end point was all-cause mortality. Secondary end points included rates of 30-day mortality, stroke, acute kidney injury, and incidence of repeat revascularization. RESULTS: The median duration of follow-up was 4.3 years (range, 1.59-6.71 years). CABG was associated with improved long-term survival compared with PCI after risk adjustment (hazard ratio, 0.59; 95% confidence interval, 0.50-0.71; P \u3c .01). Although CABG and PCI had similar 30-day mortality rates (P = .14), CABG was associated with a higher frequency of stroke (P \u3c .001) and acute kidney injury (P \u3c .001), whereas PCI was associated with a higher incidence of repeat revascularization (P \u3c .001). CONCLUSIONS: Among patients with reduced ejection fraction and multivessel disease, CABG was associated with improved long-term survival compared with PCI. CABG should be strongly considered in patients with ischemic cardiomyopathy and multivessel coronary disease

Abstract 42: Differences in Presentation, Process, and Outcomes of Aortic Valve Surgery for Women versus Men

BACKGROUND: There is a rich literature on differences in process and outcomes for women versus men undergoing coronary revascularization. Much less is known about gender differences for patients undergoing valve replacement surgery. HYPOTHESIS: Extrapolating from revascularization, women undergoing aortic valve replacement (AVR) for aortic stenosis would have greater severity of illness, more comorbidities and worse outcomes than men. METHODS: From our Northern New England Cardiac Surgery Registry we identified 4133 patients who underwent AVR for severe stenosis (area &lt;1.0 cm2) between 1/1/2000-12/31/2010; 2144 isolated AVRs and 1969 AVR+CABG. We compared severity of illness, comorbidities, the process of care, and in-hospital outcomes for women versus men, stratifying by concomitant CABG, using standard statistical techniques. RESULTS: Women comprised 47.9% of AVRs and 36.4% of AVR+CABGs. In the AVR population women were older, smaller, had more symptoms of heart failure but had less renal and coronary disease. They had shorter pump runs despite being more likely to receive blood products. Outcomes were similar to those in men including mortality (3.5% v 2.2% women v men; adjusted OR 1.32, 95%CI 0.71-2.44). In the AVR+CABG population women were older, smaller, and had more hypertension but less vascular disease and multivessel coronary disease. Again, pump runs were shorter but the use of blood products was greater. Mortality was higher for women than men (7.5% women v 3.8% men; adjusted OR 2.12, 95%CI 1.32-3.43) with no difference in other outcomes. CONCLUSION: In-hospital outcomes for women undergoing isolated AVR are comparable to those in men. However, as with isolated CABG, AVR+CABG is associated with higher mortality for women than for men. Why this is true remains to be determined. </jats:p