Long-term prosthesis-related and sudden cardiac-related complications after valve replacement for aortic stenosis.
Predictability of prosthesis-related and sudden cardiac-related complications was examined in 630 patients who were alive 30 days after valve replacement (1965 to 1986) for aortic stenosis. Follow-up totaled 4,072 patient-years. A variety of prosthetic valves, mainly mechanical, were used. The Cox regression model was used to identify independent risk factors and to estimate predicted event-freedoms relative to combinations of these risk factors. There were no risk factors for endocarditis (0.5 +/- 0.1 [number of events per 100 patient-years +/- the standard error]). Except for "other" prosthesis-related complications (0.4 +/- 0.1), adversely influenced by porcine bioprostheses (n = 15) and by the Lillehei-Kaster prosthesis (n = 25), only factors underlying diseased preoperative patient/cardiac status had predictive influence. Predicted 10-year event-freedoms for low-risk versus high-risk estimate were 86% versus 73% for thromboembolism (1.7 +/- 0.2), 95% versus 32% for anticoagulant-related hemorrhage (2.4 +/- 0.2), 69% versus 36% for all prosthesis-related complications (5.0 +/- 0.4), 93% versus 0% for sudden cardiac-related events (myocardial infarction and arrhythmia) (1.8 +/- 0.2), and 66% versus 0.5% for combined prosthesis-related and sudden cardiac-related morbidity and mortality (6.8 +/- 0.4). In 193 patients with coronary arteriography, coronary artery disease was a significant risk factor for each of the complication modalities examined except other prosthesis-related complications, prosthesis replacement, and endocarditis. Deciding to operate early in the course of aortic stenosis might "actively" reduce the rate of these complications.
Lund
O
O
Department of Thoracic and Cardiovascular Surgery, Skejby Sygehus, Aarhus University Hospital, Denmark.
Pilegaard
H K
HK
Magnussen
K
K
Knudsen
M A
MA
Nielsen
T T
TT
Albrechtsen
O K
OK
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging; D004696:Endocarditis / Q000209:etiology; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects* / Q000401:mortality; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate; D013923:Thromboembolism / Q000209:etiology / Q000401:mortality
D000925:Anticoagulants