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Focus on Surgical TAVR: Impact on Complications on Short- and Midterm-Outcome and Implications for Preoperative Risk Assesment
Maximilian Scherner, Jr., Navid Madershahian, Svenjy Ney, Kathrin Kuhr, Tanja Rudolph, Yeong Hoon Choi, Elmar Kuhn, Thorsten Wahlers.
University Hospital of Cologne, Cologne, Germany.

Objective: We investigated complications after surgical TAVR, analyzed the impact of specific complications on 30-day and midterm-outcome (VARC II Endpoints) and developed a risk-stratification-model to determine the impact of relevant comorbidities. Methods: 195 patients underwent transapical (TA) or transaortic (Tao)- AVR between January 2009 and December 2012. The prospectively collected data were used to perform elaborate uni- and multivariate risk factor analysis as well as survival analysis. Results: 30-day mortality was 12.3%, most frequent periprocedural complications were acute kidney Injury (41%), bleeding (12.8%), intraoperative CPB-use (9.7%) and intraoperative CPR (9.2%). COPD (OR 2.76,95%, CI (1.37-5.57); p=0.005), prior myocardial infarction (OR 2.24 (0.97-5.17); p=0.059) and logistic EuroSCORE>20% (OR 2.54 (1.29-4.99); p=0.007) were independent multivariable predictors for diminished 30-day-safety, whereas preoperative hemoglobin <12mg/dl ( OR 2.34 (1.10-4.98) and logistic EuroSCORE >20% (OR 2.74 (1.23-6.07) were predictors for diminished 1 year survival. Complications (i.e. intraoperative cardiopulmonary resuscitation, cardiopulmonary bypass use, Pneumonia, SIRS, Stroke, catecholamine-support) were analyzed in separate models and adjusted for preoperative factors to determine their impact on 30-day and 1-year outcome. Aditionally, we calculated a risk-stratification-model based on the results of the multivariable analysis to allow a preoperative assessment of 30-day and one-year outcome in dependency on preoperative comorbidities. Conclusion: Surgical-TAVR patients represent a specific entity in terms of preoperative factors and perioperative complications. Our analysis allows the assessment of the impact of preoperative and perioperative factors on the outcome after surgical-TAVR as long as a specific TAVR-Score is missing.

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