Abstract
Background: Studies on very long-term outcomes after aortic valve replacement are sparse. Methods: In this retrospective cohort study, long-term outcomes during 25.1 ± 2.8 years of follow-up were determined in 673 patients who underwent aortic valve replacement with or without concomitant coronary artery bypass surgery for severe aortic stenosis and/or regurgitation. Independent predictors of decreased long-term survival were determined. Cumulative incidence rates of major adverse events in patients with a mechanical versus those with a biologic prosthesis were assessed, as well as of major bleeding events in patients with a mechanical prosthesis under the age of 60 versus those above the age of 60. Results: Impaired left ventricular function, severe prosthesis–patient mismatch, and increased aortic cross-clamp time were independent predictors of decreased long-term survival. Left ventricular hypertrophy, a mechanical or biologic prosthesis, increased cardiopulmonary bypass time, new-onset postoperative atrial fibrillation, and the presence of symptoms did not independently predict decreased long-term survival. The risk of major bleeding events was higher in patients with a mechanical in comparison with those with a biologic prosthesis. Younger age (under 60 years) did not protect patients with a mechanical prosthesis against major bleeding events. Conclusions: Very long-term outcome data are invaluable for careful decision-making on aortic valve replacement.
Highlights
Publications on diagnosis and treatment of valvular heart disease tend to focus on new technologies [1,2,3,4]
Values are presented as mean ± standard deviation
But not moderate, prosthesis–patient mismatch (PPM) was an independent predictor of decreased long-term survival after aortic valve replacement (AVR) with or without concomitant coronary artery bypass grafting (CABG) for symptomatic or asymptomatic severe aortic stenosis (AS) and/or aortic regurgitation (AR)
Summary
Publications on diagnosis and treatment of valvular heart disease tend to focus on new technologies [1,2,3,4]. Retrospective cohort study, we aimed to determine the effect of impaired LV function, LV hypertrophy (LVH), moderate or severe prosthesis–patient mismatch (PPM), a mechanical or biologic prosthesis, ACC time, CPB time, new-onset POAF, and the presence of symptoms, on long-term survival after AVR with or without concomitant CABG for symptomatic or asymptomatic severe aortic stenosis (AS) and/or aortic regurgitation (AR). Methods: In this retrospective cohort study, long-term outcomes during 25.1 ± 2.8 years of follow-up were determined in 673 patients who underwent aortic valve replacement with or without concomitant coronary artery bypass surgery for severe aortic stenosis and/or regurgitation. A mechanical or biologic prosthesis, increased cardiopulmonary bypass time, new-onset postoperative atrial fibrillation, and the presence of symptoms did not independently predict decreased long-term survival. Conclusions: Very long-term outcome data are invaluable for careful decisionmaking on aortic valve replacement
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