[Survival and predictive factors of late mortality in the surgical treatment of aortic stenosis].
OBJECTIVE
Study of 161 patients submitted to aortic valve replacement due to aortic stenosis to evaluate survival and predictive factors of late mortality.


METHODS
The mean age was 45.8 years +/- 13.2 and 122 patients were men. Surgical mortality was 6.8%. The survival actuarial curve showed 59.28% of the patients alive after 16 years. Among the survival 62.3% +/- 10% were event free, including prosthesis thrombosis, thromboembolism, infective endocarditis and reoperation. Symptoms, age, gradient LV/Ao, ejection fraction (EF) and the compliance (CO) were related to prognosis. Sudden death after surgery was studied, with incidence of the 0.8 events/100 patients year.


RESULTS
The asymptomatic patients had better evolution than symptomatic (p less than 0.05). The age above 60 years was not predictive of the prognosis in 10 years of follow-up, but no patients survived after 10 years. The gradient LV/Ao was not an important factor in the survival. The group with EF greater than 50% had 66.4% of survival, while the group with EF less than 50% survival was 39%. Normal or decreased compliance was not important in the survival. All patients with EF less than 50% always has decreased CO. Fifteen patients were dead due to heart failure and the most important predictive factor was the left ventricular dysfunction (p = 0.02).


CONCLUSIONS
In aortic stenosis: a) severe ventricular dysfunction does not preclude the surgical treatment; b) the actuarial analysis suggests that EF less than 50% determines worse prognosis and always occurs with decreased CO; c) the excellent evolution of the asymptomatic patients does not generalize the surgical treatment in this phase; d) the incidence of the sudden death was not high after the surgical treatment; e) patients with pre-operative left ventricular dysfunction had greater mortality due to heart failure, than patients with normal left ventricular function; f) despite of the morbid events our results confirm the real benefit of the surgical treatment in the aortic stenosis.
Jacob
J L
JL
Instituto de Moléstias Cardiovasculares (IMC), São José do Rio Preto, SP.
Garzon
S A
SA
Machado
N C
NC
Lorga
A M
AM
Nicolau
J C
JC
Greco
O T
OT
Braile
D M
DM
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery; D002648:Child; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
Sobrevida e fatores preditivos da mortalidade tardia no tratamento cirúrgico da estenose aórtica.