title: Can the results of contemporary aortic valve replacement be improved?
abstract: Although the results of contemporary aortic valve replacement are excellent, cardiac surgeons must identify the factors that predict postoperative morbidity and mortality to develop alternative strategies for high-risk patients. Two hundred seventy-seven consecutive patients undergoing isolated aortic valve replacement between 1982 and 1984 were evaluated. Thirty-seven clinical and 13 preoperative hemodynamic variables were analyzed by univariate and multivariate statistics to determine the risk factors for postoperative morbidity and mortality. The operative mortality was 3%, the incidence of a postoperative low output syndrome was 12%, and the incidence of a perioperative myocardial infarction was 5%. A multivariate, logistic regression analysis found that age was the only the only independent predictor of mortality. Three factors independently predicted postoperative low output syndrome: age, the presence of coronary artery disease, and the peak systolic gradient in patients with aortic stenosis. Patients with aortic stenosis had a higher incidence of postoperative ventricular dysfunction (17%) than those with mixed valvular disease (9%) or aortic regurgitation (5%). Perioperative myocardial infarction was predicted by the extent of coronary artery disease. The incidence of perioperative myocardial infarction was higher in patients with triple-vessel coronary artery disease (13%) and those with left main stenosis (18%) than in patients with single- or double-vessel disease (4%) or those without coronary artery disease (4%). Because of the higher risk of aortic valve replacement in older patients, the risk-benefit ratio of the operation must be carefully assessed in the elderly. Improved methods of myocardial protection may reduce the risks for patients with aortic stenosis and symptomatic triple-vessel coronary artery disease.
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis / Q000401:mortality; D001794:Blood Pressure; D006328:Cardiac Catheterization; D002302:Cardiac Output; D006349:Heart Valve Diseases / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011183:Postoperative Complications; D011446:Prospective Studies; D012044:Regression Analysis; D012306:Risk