title: [Heart valve substitution: the effect of preoperative findings on long-term outcome].
abstract: BACKGROUND
  In a retrospective analysis of 653 consecutive patients who underwent heart valve replacement by one single type of mechanical prosthesis (St. Jude Medical) at three Swiss university medical centers (Basel, Bern, Lausanne), the outcome was judged on the basis of preoperative variables. These variables should facilitate the timing of heart valve replacement.
  
  
  METHODS
  Preoperative evaluation includes NYHA classification of symptoms, chest X-ray, ECG, and LVEF on angiography. Postoperative outcome was assessed clinically at yearly intervals by NYHA classification, documentation of complications and mortality.
  
  
  RESULTS
  Five-year-survival rates were 96 and 88%, and complication-free rates were 82 and 76% respectively in patients after isolated aortic and mitral valve replacement. An unsatisfactory outcome with death or persistent severe symptoms was more frequent when preoperative symptoms at rest and atrial fibrillation were present.
  
  
  CONCLUSIONS
  Heart valve replacement should not be postponed until severe symptoms and functional impairment occur. Clinical criteria are at least as important for the timing of operation as the findings of more complex investigations.
authors: Kardiologische Abteilungen und Herzchirurgische Kliniken, Universitätsspitäler Basel.
authors: A
authors: A
authors: Hoffmann
authors: S
authors: S
authors: Vogt
authors: J
authors: J
authors: Roth
authors: E
authors: E
authors: Grädel
authors: U
authors: U
authors: Althaus
authors: J J
authors: JJ
authors: Goy
authors: H
authors: H
authors: Sadeghi
authors: D
authors: D
authors: Burckhardt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D006334:Heart Function Tests; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000401:mortality; D006801:Humans; D007223:Infant; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D012189:Retrospective Studies; D016019:Survival Analysis
vernacular_title: Herzklappensersatz: der Einfluss präoperativer Befunde auf das Spätresultat.