Personal follow-up of 100 aortic valve replacement patients for 1081 patient years.
BACKGROUND
Anticoagulant related complications, prosthetic valve endocarditis and periprosthetic leakage are the most serious complications after aortic valve replacement. In this study, aortic valve replacement patients were followed-up to evaluate the importance of mechanical valve type to the prognosis of the patients.


METHODS
The clinical course in 100 patients who had undergone aortic valve replacement with first generation prosthetic disc valves, was followed personally by the author at three separate time-points, 6, 10 and 14 years postoperatively, giving a total of 1081 follow-up years. The mean operation age of the patients was 47.1 years (range, 23 to 70 years). There were 33 patients with aortic stenosis, 50 with aortic regurgitation and 17 with combined aortic valve failure.


RESULTS
During the follow-up there were nine events of anticoagulation induced bleeding, incidence 0.83/100 patient-years (pty), [95% confidence interval (CI), 0.39-1.57/100 pty]. The incidence of embolic complications was 0.56/100 pty, [0.20-1.20/100 pty], that of prosthetic valve endocarditis 0.65/100 pty, [0.26-1.32/100 pty] and that for periprosthetic leakage 0.37/100 pty, [0.05-0.81/100 pty]. Freedom from all valve-related events was 73.8%, [62.3-85.3%] at 10 years.


CONCLUSIONS
On the basis of the results with first generation disc valves, it is concluded that the clinically most important factor predicting long-term complications in addition to patient selection and timing of operation is the quality of postoperative management, prevailing even over significant technical improvements.
Varstela
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Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D004696:Endocarditis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects* / Q000145:classification; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016019:Survival Analysis; D013923:Thromboembolism / Q000209:etiology; D016896:Treatment Outcome
D000925:Anticoagulants