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Ann Thorac Surg 2007;83:2036-2043
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Long-Term Consequences of Postoperative Heart Failure After Surgery for Aortic Stenosis Compared With Coronary Surgery

Farkas B. Vánky, MD, PhDa, Erik Håkanson, MD, PhDb, Rolf Svedjeholm, MD, PhDa,*

a Department of Cardiothoracic Surgery, University Hospital, Linköping, Sweden
b Department of Cardiothoracic Anesthesia, University Hospital, Linköping, Sweden

Accepted for publication January 22, 2007.

* Address correspondence to Dr Svedjeholm, Department of Cardiothoracic Surgery, University Hospital, Linköping, SE-581 85, Sweden (Email: rolf.svedjeholm{at}lio.se).

Background: Although postoperative heart failure is a major determinant of operative mortality in cardiac surgery it has received little attention in the literature, and long-term consequences remain to be addressed. Therefore, the impact of postoperative heart failure on long-term survival in relation to other risk factors was studied.

Methods: All patients undergoing aortic valve replacement (AVR) for aortic stenosis from 1995 through 2000 in the southeast region of Sweden (n = 398) were compared with a cohort, matched for age and sex, undergoing coronary artery bypass grafting (CABG [n = 398]). Risk factors for 5-year mortality were analyzed.

Results: Forty-five AVR and 47 CABG patients required treatment for postoperative heart failure. Thirty-day, 1-year, and 5-year mortality in patients with and without postoperative heart failure after AVR were 6.7% versus 1.4% (p = 0.05), 8.9% versus 4.0% (p = 0.13), and 42.2% versus 14.2% (p < 0.0001) respectively. Corresponding results in the CABG group were 21.3% versus 1.1% (p < 0.0001), 25.5% versus 3.1% (p < 0.0001), and 36.2% versus 11.1% (p = 0.0015). Postoperative heart failure, preoperative renal dysfunction, procedure-associated stroke, body mass index less than 19 kg/m2, older age, preoperative atrial fibrillation, and preoperative anemia turned out as independent risk factors for 5-year mortality after AVR. In the CABG group, postoperative heart failure, diabetes mellitus, older age, and procedure-associated stroke emerged as independent risk factor for 5-year mortality.

Conclusions: Postoperative heart failure was associated with high early mortality after CABG whereas the grave consequences of postoperative heart failure after AVR for aortic stenosis became evident only with time.






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