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.
Department of Thoracic and Cardiovascular Surgery, Skejby Sygehus, Aarhus University Hospital, Denmark.
O
O
Lund
H K
HK
Pilegaard
K
K
Magnussen
M A
MA
Knudsen
T T
TT
Nielsen
O K
OK
Albrechtsen
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