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Snemmkominn árangur opinna ósæðarlokuskipta við ósæðarlokuþrengslum hjá konum á Íslandi
Univ Iceland, Fac Med, Reykjavik, Iceland.
Univ Iceland, Fac Med, Reykjavik, Iceland.
Landspitali Univ Hosp, Dept Cardiothorac Surg, Reykjavik, Iceland.
Univ Iceland, Fac Med, Reykjavik, Iceland.
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2019 (Icelandic)In: Laeknabladid: The icelandic medical journal, ISSN 0023-7213, E-ISSN 1670-4959, Vol. 105, no 5, p. 215-221Article in journal (Refereed) Published
Abstract [en]

Introduction: Aortic valve replacement (AVR) for aortic stenosis (AS) is the second most common open-heart procedure performed in Iceland. The aim of this study was to analyze the early outcome of AVR among females in Iceland.

Materials and methods: This was a retrospective study including 428 patients who underwent surgical AVR due to AS in Iceland from 2002-2013. Information was gathered from medical records, including pre-and postoperative results of echocardiography and complications. Overall survival was estimated (Kaplan-Meier) and logistic regression used to identify predictors of operative mortality. The median follow-up time was 8.8 years (0-16.5 years).

Results: Of the 428 patients, 151 were female (35.3%), that were on average 2 years older than men (72.6 ± 9.4 vs. 70.4 ± 9.8 yrs., p=0.020). Preoperative symptoms were similar, but women had significantly higher EurosSCORE II than men (5.2 ± 8.8 vs. 3.2 ± 4.6, p=0.002). Maximal pressure-gradient across the aortic valve was higher for women (74.4 ± 29.3 mmHg vs. 68.0 ± 23.4 mmHg, p=0,013) but postoperative complications, operative mortality (8.6% vs. 4.0%, p=0.068) and 5-year survival (78.6% vs. 83.1%, p=0.245) were comparable for women and men. Logistic regression analysis showed that female gender was not an independent predictor of 30-day mortality (OR 1.54, 95% CI 0.63-3.77).

Conclusions: Females constitute one third of patients that undergo AVR for AS in Iceland. At the time of surgery females are two years older than men and appear to have a more significant aortic stenosis at the time of surgery. However, complication rates, operative mortality and long-term survival were comparable for both genders.

Abstract [is]

Inngangur: Ósæðarlokuskipti er önnur algengasta hjartaskurðaðgerðin á Íslandi. Markmið rannsóknarinnar er að meta í fyrsta sinn á Íslandi snemmkominn árangur opinna ósæðarlokuskipta vegna ósæðarlokuþrengsla hjá konum.

Efniviður og aðferðir: Afturskyggn rannsókn á 428 sjúklingum sem gengust undir opin ósæðarlokuskipti vegna ósæðarlokuþrengsla á Íslandi 2002-2013. Upplýsingar fengust úr sjúkraskrám og voru skráðir fylgikvillar aðgerðar og farið var yfir hjartaómanir fyrir og eftir aðgerð. Forspárþættir dauða innan 30 daga voru metnir með lógistískri aðhvarfsgreiningu og heildarlifun áætluð (Kaplan-Meier). Miðgildi eftirfylgdartíma var 8,8 ár (0-16,5 ár).

Niðurstöður: Af 428 sjúklingum voru 151 konur (35,3%) og voru þær að meðaltali tveimur árum eldri en karlar (72,6 ± 9,4 ára á móti 70,4 ± 9,8, p=0,020). Einkenni fyrir aðgerð voru sambærileg milli kynja en konur höfðu marktækt hærra EuroSCORE II fyrir aðgerð (5,2 ± 8,8 á móti 3,2 ± 4,6, p=0,002). Hámarks-þrýstingsfall yfir ósæðarlokuna var hærra hjá konum (74,4 ± 29,3 mmHg á móti 68,0 ± 23,4 mmHg, p=0,013) en tíðni snemmkominna fylgikvilla, bæði minniháttar og alvarlegra, var sambærileg milli kynja líkt og 30 daga dánartíðni (8,6% á móti 4,0%, p=0,076) og 5 ára lifun (80,1% á móti 83,0% fyrir karla, p=0,49). Kvenkyn reyndist ekki vera forspárþáttur fyrir dauða innan 30 daga þegar leiðrétt var fyrir öðrum þekktum forspárþáttum dauða (ÁH: 1,54, 95%-ÖB: 0,63-3,77) svo sem aldri.

Ályktanir: Á Íslandi eru konur um þriðjungur þeirra sem gangast undir ósæðarlokuskipti vegna ósæðarlokuþrengsla. Þær eru rúmlega tveimur árum eldri en karlar þegar kemur að aðgerð og virðast hafa lengra gengin ósæðarlokuþrengsli. Tíðni fylgikvilla eftir aðgerð, 30 daga dánartíðni og langtímalifun var engu að síður sambærileg hjá kynjunum.

Place, publisher, year, edition, pages
2019. Vol. 105, no 5, p. 215-221
Keywords [en]
aortic stenosis, aortic valve replacement, females, outcome, complications, survival
National Category
Surgery Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-383895DOI: 10.17992/lbl.2019.05.230ISI: 000467210400001PubMedID: 31048555OAI: oai:DiVA.org:uu-383895DiVA, id: diva2:1317914
Note

Title in WoS: Early outcome of surgical aortic valve replacement for aortic stenosis in Icelandic females

Available from: 2019-05-24 Created: 2019-05-24 Last updated: 2019-05-24Bibliographically approved

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Helgadottir, Solveig

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