Late incidence and predictors of persistent or recurrent heart failure in patients with aortic prosthetic valves.
BACKGROUND
We examined factors associated with persistent or recurrent congestive heart failure after aortic valve replacement.


METHODS
Patients who underwent aortic valve replacement with contemporary prostheses (n = 1563) were followed up with annual clinical assessment and echocardiography. The effect of demographic, comorbid, and valve-related variables on the composite outcome of New York Heart Association class III or IV symptoms or congestive heart failure death after surgery was evaluated with stratified log-rank tests, Cox proportional hazard models, and logistic regression. Factors associated with all-cause death were also examined. Prediction models were bootstrapped 1000 times.


RESULTS
Total follow-up was 6768 patient-years (mean, 4.3 +/- 3.3 years; range, 60 days to 17.1 years). Freedom from congestive heart failure or congestive heart failure death was 98.6% +/- 0.3%, 88.6% +/- 1.0%, 73.9% +/- 2.3%, and 45.2% +/- 8.5% at 1, 5, 10, and 15 years, respectively. Age, preoperative New York Heart Association class, left ventricular grade, atrial fibrillation, coronary artery disease, smoking, and redo status predicted congestive heart failure after surgery (all P <.05). Larger prosthesis size and effective orifice area, both absolute and indexed for body surface area, were independently associated with freedom from congestive heart failure. Increased transprosthesis gradients were predicted by prosthesis-patient mismatch and were associated with congestive heart failure after surgery. Mismatch defined as an effective orifice area/body surface area of 0.80 cm(2)/m(2) or less was a significant predictor of congestive heart failure events after surgery, but mismatch defined as an effective orifice area/body surface area of 0.85 cm(2)/m(2) or less was not. Small prosthesis size and mismatch were not significantly associated with all-cause mortality.


CONCLUSIONS
These analyses identify independent predictors of congestive heart failure symptoms and congestive heart failure death late after aortic valve replacement and indicate that prosthesis size has a significant effect on this cardiac end point, but not on overall survival after aortic valve replacement.
Ruel
Marc
M
Division of Cardiac Surgery, Department of Epidemiology, University of Ottawa, Ontario, Canada. mruel@ottawaheart.ca
Rubens
Fraser D
FD
Masters
Roy G
RG
Pipe
Andrew L
AL
Bédard
Pierre
P
Hendry
Paul J
PJ
Lam
B Khanh
BK
Burwash
Ian G
IG
Goldstein
William G
WG
Brais
Maurice P
MP
Keon
Wilbert J
WJ
Mesana
Thierry G
TG
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011475:Prosthesis Failure; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis