Predictors for Length of Stay after Surgical Aortic Valve Replacement

Till Joscha Demal; Nico Arndt; Oliver D. Bhadra; Sebastian Ludwig; David Grundmann; Lisa Voigtlaender-Buschmann; Lara Waldschmidt; Laura Hannen; Stefan Blankenberg; Paulus Kirchhof; Lenard Conradi; Hermann Reichenspurner; Niklas Schofer; Andreas Schaefer

doi:10.1055/a-2466-7245

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg
DOI: 10.1055/a-2466-7245

Original Cardiovascular

Predictors for Length of Stay after Surgical Aortic Valve Replacement

Till Joscha Demal^*

¹Department of Cardiac and Vascular Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany

,

Nico Arndt ^*

¹Department of Cardiac and Vascular Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany

,

Oliver D. Bhadra

¹Department of Cardiac and Vascular Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany

,

Sebastian Ludwig

²Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Hamburg, Germany

,

David Grundmann

²Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Hamburg, Germany

,

Lisa Voigtlaender-Buschmann

²Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Hamburg, Germany

,

Lara Waldschmidt

²Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Hamburg, Germany

,

Laura Hannen

²Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Hamburg, Germany

,

Stefan Blankenberg

²Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Hamburg, Germany

,

Paulus Kirchhof

²Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Hamburg, Germany

,

Lenard Conradi

¹Department of Cardiac and Vascular Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany

,

Hermann Reichenspurner

¹Department of Cardiac and Vascular Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany

,

Niklas Schofer

²Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Hamburg, Germany

,

Andreas Schaefer

³Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Hamburg, Germany

› Author Affiliations

Abstract

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Abstract

Objectives Aortic valve replacement improves and prolongs lives of patients with aortic valve disease, but requires significant healthcare resources, which are mainly determined by the length of associated hospital stays. Therefore, this study aims to identify risk factors for extended length of stay after surgical aortic valve replacement.

Methods Between 2018 and 2023, 458 consecutive patients underwent isolated surgical aortic valve replacement at our center and were included in our analysis. To identify independent predictors for hospital and intensive care unit stay, multivariable linear regression analysis using backward elimination process was performed.

Results Upon multivariable linear regression, endocarditis (regression coefficient [β] 2.98; 95% confidence interval [CI] 1.51, 4.45; p < 0.001]) and prior aortic valve surgery (β 1.72; 95% CI 0.18, 3.26; p = 0.029) were associated with prolonged hospital stay. Prior aortic valve surgery was associated with prolonged intensive care unit stay (β 0.99; 95% CI 0.39, 1.59; p = 0.001) as well as chronic obstructive pulmonary disease (COPD) (β 1.61; 95% CI 0.66, 2.55; p = 0.001), smaller prosthetic valve sizes (β −0.18; 95% CI −0.30, −0.06; p = 0.003), preoperative atrial fibrillation (β 1.06; 95% CI 0.32, 1.79; p = 0.005), and reduced left ventricular ejection fraction (β −0.03; 95% CI −0.05, −0.01; p = 0.006).

Conclusion Pending further validation, structured programs aiming to accelerate intensive care unit and hospital discharge after surgical aortic valve replacement should focus on patients with prior cardiac surgery, atrial fibrillation, and COPD. Surgeons should aim to implant large-diameter valves. Furthermore, the identified predictors should be used to discuss surgical versus transcatheter procedures in the interdisciplinary heart team.

Keywords

heart valve surgery - aortic valve and root - heart valve - transapical - percutaneous (TAVI)

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References

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