131: Long-term outcomes following isolated mechanical aortic valve repalcement in young adults

Abstract

The ideal aortic valve substitute for young adults (<65 years) undergoing isolated aortic valve replacement (AVR) remains unknown. This is partly due to the lack of data on long-term outcomes in this specific patient population. The aim of this study was to determine long-term outcomes (survival and valve-related complications) in a contemporary series of consecutive young adults undergoing isolated mechanical AVR. Between 1997 and 2006, 1159 patients underwent AVR at our institution. All patients undergoing concomittant or redo procedures were excluded. Of those, 470 patients <65 years of age undergoing isolated mechanical AVR were identified. Mean age of the patients was 53.2±9.2 years (303 male and 167 female). Long term follow-up data were prospectively collected through a dedicated valve clinic. Additional information was obtained retrospectively from medical records. Lifetable analyses were used to determine age- and gender-matched general population survival in the province. Mean follow up was 4.7±4.7 years. Overall actuarial survival at 1, 5 and 10 years was respectively 98±2%, 93±2% and 80±3%, which is lower than the age- and gender-matched general population in the province (Figure). Actuarial freedom from prosthetic valve dysfunction was 99±1%, 92±2% and 88±8% at 1, 5 and 10 years respectively. Actuarial freedom from valve reintervention was 98±1%, 93±1% and 89±2% at 1, 5 and 10 years respectively. Actuarial freedom from thrombo-embolism was 96±1%, 90±2% and 87±2% at 1, 5 and 10 years respectively. In young adults undergoing isolated mechanical AVR, survival is lower than expected in an age- and gender-matched general population. Furthermore, there is a low but constant hazard of prosthetic valve reintervention following mechanical AVR. Further studies are required to determine the ideal valve substitute in young adults undergoing AVR.