Prediction of long-term complications associated with aortic valve prostheses. A 10-17 year follow-up.
Long-term complications following implantation of aortic valve prosthesis were assessed in 139 patients who had survived greater than 30 postoperative days (maximum follow-up 17 years). Most of the prostheses were Starr-Edwards valves (38 silastic ball, SESB, and 96 cloth-covered, SECC). All patients received maintenance coumarin. The rate of thromboembolic complications was 1.6/100 patient-years, without difference between SESB and SECC valves although there were no episodes with SESB from 6 years postoperatively. The overall rate of valve-related complications (VRC)--thromboembolism, hemorrhage, endocarditis, re-replacement, etc.--was 4.2/100 patient-years. High preoperative cardiothoracic index (CTI) significantly increased the incidence of VRC. Preoperative NYHA class III-IV and high CTI similarly influenced the rate of serious VRC (= VRC excluding extremity emboli, epistaxis and subcutaneous bleeding). The valve-and-heart-related morbidity (= VRC including myocardial infarction and pacemaker requirement) was also influenced by preoperative CTI. The long-term complications thus were not exclusively attributable to the prosthesis, but also to preoperative patient-related data.
Lund
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Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Denmark.
D000328:Adult; D000368:Aged; D001021:Aortic Valve; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects* / Q000401:mortality; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013923:Thromboembolism / Q000453:epidemiology