Replacement of aortic valve combined with myocardial revascularization: determinants of early and late risk for 500 patients, 1967-1981.
Five hundred consecutive patients underwent aortic valve replacement and coronary revascularization in the years from 1967 to 1981, with 29 (5.9%) in-hospital deaths. Current operative mortality (1978-1981) is 3.4%. Univariate and multivariate analyses were used to identify determinants of early and late risk. Female sex, aortic insufficiency, and advanced age increased in-hospital mortality, whereas use of cardioplegia decreased it. At follow-up of 471 patients who survived hospitalization for 1 to 135 months (mean 41) after surgery, 96 late deaths were documented. Survival rates were 87%, 80%, and 55%, and event-free survival rates were 80%, 65%, and 39% at 2, 5, and 10 years after surgery, respectively. The late survival rate was unfavorably influenced by the presence of moderately or severely impaired left ventricular function and double-vessel coronary disease; the rate was enhanced for patients in age group from 50 to 59 years old and was not influenced by the method of myocardial protection. The event-free survival rate decreased with the presence of moderately or severely impaired left ventricular function and was enhanced for patients with New York Heart Association class I or II symptoms before surgery. Patients with bioprostheses who did not receive anticoagulants had higher survival and event-free survival rates than did either patients with bioprostheses who received anticoagulants or patients with mechanical valves, whether they received anticoagulants or not.
D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001021:Aortic Valve; D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced; D006350:Heart Valve Prosthesis / Q000401:mortality*; D006801:Humans; D007432:Intraoperative Period / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000401:mortality*; D009820:Ohio; D012306:Risk; D012737:Sex Factors; D013997:Time Factors
D000925:Anticoagulants