Predictors for Length of Stay after Surgical Aortic Valve Replacement

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)

^* These authors contributed equally to the mansuscript and share the first-authorship.

Data Availability Statement

The data underlying this article cannot be shared publicly due to the privacy of individuals that participated in the study. The data will be shared on reasonable request to the corresponding author. The data are stored in our aortic valve registry (“HARbOR,” NCT NCT04227002) at the Heart and Vascular Center Hamburg.

Authors' Contribution

Based on the ICMJE criteria, T.D., N.A., and A.S. contributed to study design, data collection, analysis, interpretation, manuscript writing, and review. O.B., S.L., D.G., L.V., L.W., L.H., and N.S. were responsible for data collection and manuscript review. S.B., P.K., L.C., and H.S. handled study design and manuscript review. All participants approved the final version for publication and take full responsibility for the work's integrity and accuracy. TD and NA contributed equally to the research work and writing of the manuscript.

Publication History

Received: 11 September 2024

Accepted: 12 November 2024

Accepted Manuscript online:
13 November 2024

Article published online:
19 March 2025

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