TY - JOUR
T1 - Impact of bendopnea on postoperative outcomes in patients with severe aortic stenosis undergoing aortic valve replacement
AU - Dominguez-Rodriguez, Alberto
AU - Thibodeau, Jennifer T
AU - Ayers, Colby R.
AU - Jimenez-Sosa, Alejandro
AU - Garrido, Pilar
AU - Montoto, Javier
AU - Prada-Arrondo, Pablo C.
AU - Abreu-Gonzalez, Pedro
AU - Drazner, Mark H
N1 - Publisher Copyright:
VC The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - OBJECTIVES: Bendopnea is a recently described symptom of advanced heart failure. Its prevalence and prognostic utility in other cardiac conditions are unknown. METHODS: We prospectively enrolled 108 consecutive patients (75 ± 3 years, 68% men) with severe symptomatic aortic stenosis referred for surgical aortic valve replacement (SAVR). Preoperatively, patients were tested for bendopnea, which was considered to be present when dyspnoea occurred within 30 s of bending forward. Univariable and stepwise multivariable analyses tested the association of bendopnea with preoperative echocardiographic parameters and postoperative clinical outcomes. RESULTS: Bendopnea was present in 46 of 108 (42%) patients. The mean time of onset was 10.5 ± 3.4 s. Bendopnea was associated with higher estimated pulmonary artery systolic pressures [51 (11) mmHg vs 40 (11) mmHg), P < 0.0001], smaller aortic valve area [0.66 (0.16) cm2 vs 0.76 (0.13) cm2, P = 0.0006] and longer duration of mechanical ventilation (P = 0.002) and length of stay in the hospital (P = 0.007). Following SAVR, in-hospital mortality in those with bendopnea versus those without bendopnea was 13% vs 3% (P = 0.07). In multivariable analysis, bendopnea was associated with duration of mechanical ventilation (parameter estimate 2.4, P < 0.0001) and length of stay in the hospital (parameter estimate 10.2, P <_ 0.0001). CONCLUSIONS: Bendopnea was present in a sizeable minority of patients (42%) with severe aortic stenosis referred for SAVR. Bendopnea was associated with higher pulmonary artery systolic pressure and smaller aortic valve area preoperatively and with longer duration of mechanical ventilation and length of hospitalization postoperatively. These data suggest that bendopnea provides prognostic information in patients with severe aortic stenosis undergoing SAVR.
AB - OBJECTIVES: Bendopnea is a recently described symptom of advanced heart failure. Its prevalence and prognostic utility in other cardiac conditions are unknown. METHODS: We prospectively enrolled 108 consecutive patients (75 ± 3 years, 68% men) with severe symptomatic aortic stenosis referred for surgical aortic valve replacement (SAVR). Preoperatively, patients were tested for bendopnea, which was considered to be present when dyspnoea occurred within 30 s of bending forward. Univariable and stepwise multivariable analyses tested the association of bendopnea with preoperative echocardiographic parameters and postoperative clinical outcomes. RESULTS: Bendopnea was present in 46 of 108 (42%) patients. The mean time of onset was 10.5 ± 3.4 s. Bendopnea was associated with higher estimated pulmonary artery systolic pressures [51 (11) mmHg vs 40 (11) mmHg), P < 0.0001], smaller aortic valve area [0.66 (0.16) cm2 vs 0.76 (0.13) cm2, P = 0.0006] and longer duration of mechanical ventilation (P = 0.002) and length of stay in the hospital (P = 0.007). Following SAVR, in-hospital mortality in those with bendopnea versus those without bendopnea was 13% vs 3% (P = 0.07). In multivariable analysis, bendopnea was associated with duration of mechanical ventilation (parameter estimate 2.4, P < 0.0001) and length of stay in the hospital (parameter estimate 10.2, P <_ 0.0001). CONCLUSIONS: Bendopnea was present in a sizeable minority of patients (42%) with severe aortic stenosis referred for SAVR. Bendopnea was associated with higher pulmonary artery systolic pressure and smaller aortic valve area preoperatively and with longer duration of mechanical ventilation and length of hospitalization postoperatively. These data suggest that bendopnea provides prognostic information in patients with severe aortic stenosis undergoing SAVR.
KW - Aortic stenosis
KW - Bendopnea
KW - Physical examination
KW - Prognosis
KW - Surgical aortic valve replacement
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U2 - 10.1093/icvts/ivy174
DO - 10.1093/icvts/ivy174
M3 - Article
C2 - 29868724
AN - SCOPUS:85057531778
SN - 1569-9293
VL - 27
SP - 808
EP - 812
JO - Interactive Cardiovascular and Thoracic Surgery
JF - Interactive Cardiovascular and Thoracic Surgery
IS - 6
ER -