Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w

Biomarkers to predict outcomes after surgical aortic valve replacement or repair

T. J. Demal1, J. Bialczak1, A. Goßling1, F. M. Ojeda1, O. Bhadra2, M. Linder3, S. Ludwig3, D. Grundmann3, L. Voigtländer-Buschmann4, L. Waldschmidt4, J. Schirmer1, N. Schofer4, S. Blankenberg3, H. Reichenspurner2, L. Conradi2, M. Seiffert3, A. Schäfer2

1Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg; 2Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg; 3Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg; 4Allgemeine und Interventionelle Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg;

Background Prediction of postoperative complications after cardiac surgery is challenging. Besides established risk stratification tools (e.g. EuroSCORE, STS-Score), preoperative determination of biomarkers gains increasing importance and may be helpful to estimate postoperative adverse outcomes. To further elucidate this topic, we herein aimed to correlate preoperative biomarkers with postoperative complication rates after surgical aortic valve replacement or repair (SAVR). Methods Patients undergoing SAVR were prospectively imputed into a dedicated registry after informed consent. Exclusion criteria were concomitant replacement of the ascending aorta or the Ross-OP. Patients underwent routine preoperative sampling of these biomarkers: hemoglobin, creatinine, high-sensitive troponin I, GOT, GPT, INR, CRP, and NTproBNP. Associations of biomarker levels with postoperative complications were examined using logistic regression. All models were adjusted for EuroSCORE II. Outcome parameters were adjudicated according to VARC-3 definitions. For the regression analysis all biomarkers except hemoglobin were log-transformed due to skew distributions. Results Between 03/2018 and 10/2021, 377 consecutive patients (median age 66.4 (IQR 56.9, 74.1), 262/377 (69.5%) male, median EuroSCORE II 5.0 (IQR 1.7, 67.0)) met inclusion criteria and were analyzed. Endocarditis was the indication for surgery in 59/377 (15.6%) patients. Valve replacement and repair were performed in 350/377 (92.8%) and 18/377 (5.1%) patients, respectively. Concomitant coronary artery bypass grafting and/or mitral/tricuspid valve repair were performed in 34.0% (n=128/377). Overall 30-day mortality was 3.7% (n=14). In endocarditis, 30-day mortality was 15.2% (n=9). Postprocedural stroke was found in 2.7% (n=10). Bleeding Type 3/4 and postprocedural pacemaker implantation rates were 3.5% (n=13) and 9.1% (n=34), respectively. The combined 30-day VARC-3 endpoints early safety and clinical efficacy were reached in 73.4% (n=276) and 93.6% (n=350), respectively. Preoperative hemoglobin (OR 0.70; 95% CI: 0.55, 0.90, p=0.0049), creatinine (OR 3.44; 95% CI: 1.09, 10.86, p=0.035), hstroponin I (OR 1.52; 95% CI: 1.12, 2.07, p=0.0068), GOT (OR 2.55; 95% CI: 1.12, 5.77, p=0.025), GPT (OR 2.74; 95% CI: 1.71, 4.38, p<0.001), INR (OR 4.64; 95% CI: 1.17, 18.37, p=0.029), CRP (OR 2.33; 95% CI: 1.58, 3.45, p<0.001), and NTproBNP (OR 2.11; 95% CI: 1.30, 3.41, p=0.0025) were all significant and independent predictors for 30-day mortality. Furthermore, all these biomarkers predicted the combined endpoints early safety and clinical efficacy. Type 3/4 bleeding was predicted by hstroponin I only (OR 1.36; 95% CI: 1.00, 1.85, p=0.046) and not by INR (OR 2.57; 95% CI: 0.47, 14.13, p=0.280). None of the tested biomarkers independently correlated with postoperative stroke. Conclusion This analysis identified several biomarkers that, independently from EuroSCORE II risk stratification, predict postprocedural outcome after SAVR in terms of mortality and clinical efficacy. We cautiously assume that these biomarkers may indicate baseline cardiac and/or end-organ injury. Noteworthy, hstroponin I was predictive for postoperative bleeding events. Combined stratification models of these biomarkers with EuroSCORE II should be evaluated in further studies to improve predictive value.

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