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Master Thesis

Facteurs prédictifs de mortalité à 3 ans de la chirurgie de remplacement valvulaire aortique pour rétrécissement aortique serré dégénératif

Abstract : Background: surgical aortic valve replacement (SAVR) for degenerative aortic stenosis (AS) is the most practiced valvular surgery in the world. This study proposed to identify risk factors of 3-years-mortality for patients undergoing isolated aortic valve replacement for calcified aortic stenosis. Methods: this monocentric retrospective observational investigation of a prospectively gathered database in the university hospital of CHU de Bordeaux, France. Patients undergoing isolated AVR for severe calcified AS between September 2010 and May 2015 were included. The primary endpoint was 3-years mortality after surgery. We applied logistic regression analysis to identify independent risk factors. Results: a total of 1101 patients were included with a complete follow-up and 168 (15.3%) of whom died. Multivariable analysis identified six independent risk factors: male sex (OR 1.78, 95%CI: 1.21-2.62, p<0.01), peripheral artery disease (OR 1.77, 95%CI: 1.08-2.92, p=0.03), age (OR 1.06 per year, 95%CI: 1.04-1.09, p<0.01), pulmonary artery systolic pressure (OR 1.02 per mmHg, 95%CI: 1.01-1.03, p<0.01), platelet count (OR 1.00, 95%CI: 1.00-1.01, p=0.035), and indexed valve area (OR 0.97, 95%CI: 0.95-0.99, p<0.01). The discrimination of this logistic regression model (area under the ROC curve) for predicting 3-years mortality was 0.67 (CI95%: 0.60-0.75). The discrimination of EuroSCORE II for this outcome was 0.60 (CI95%0.56-0.65) and was similar to our model (p = 0.11). Conclusion: we found six independent risk factors for 3-year mortality after isolated AVR for AS. However, the performances of our model as those of EuroSCORE II appear to be modest for prediction mid-term mortality.
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Antoine Beurton. Facteurs prédictifs de mortalité à 3 ans de la chirurgie de remplacement valvulaire aortique pour rétrécissement aortique serré dégénératif. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02447359⟩

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