7 Assessment of post heart valve surgery outcomes in tertiary center in Scotland

Abstract

Introduction The European Society of Cardiology (ESC) 2017 guidelines on valvular heart disease recommend 30-days and 1-year echocardiography along with one year and then life-long annual follow up with cardiologist post heart valve surgery to detect early deterioration in prosthetic function or ventricular function or progressive disease of another heart valve. Aim: The aim of this study was to assess if the ESC guidelines were being adhered to after the heart valve surgery and if there was a difference in the outcomes of patients being followed up as per above guidelines compared to those who were not. Methods Data was collected retrospectively from tertiary centers in Greater Glasgow and Clyde health board region in Scotland from 2016 to 2018. Two independent clinicians checked electronic records for individual patients. Telephone calls were made to contact patients to confirm follow up arrangements if electronic records were unclear. Results 695 patients were included in the study. 58% were male (mean age 65.5 years - SEM 0.5) and 42% female (mean age 68 years - SEM 0.8). Of the total valves operated: 70% were aortic (44.9% of total were bioprosthetic AVR, 25.1% were metallic AVR), 22% mitral (12.3% of total were mitral valve repair, 9.7% were metallic MVR), 5% tricuspid and 3% pulmonary. At 30 days post-surgery, 24% of the patients had transthoracic echocardiogram done. At one year post-surgery, 66.6% had a follow up echocardiogram and 53% were clinically reviewed by a cardiologist. Death, major and minor complications as defined by the European Association of Cardiothoracic Surgeons were recorded at 1 year. Major complications recorded were thromboembolic disease, infective endocarditis and out of hospital cardiac arrests who survived. Minor complications recorded were sternal wound complications, suppurative complications, need for permanent pacemaker and new decompensated heart failure. 7% deaths (p=0.0004), 10.6% major complications (p=0.199) and 12.5% minor complications (p=0.160) were recorded in the group with no follow up, compared to 1.6%, 7.8% and 16.2% respectively in the group that was followed up (figure 1). Conclusion The mortality and morbidity rates are higher among patients not followed up regularly after heart valve surgery. The death rate is significantly higher in the group with no follow up while major and minor complications were statistically not significant between the two groups. Conflict of Interest None