title: Predictors of outcome in patients with prosthetic valve dysfunction.
abstract: OBJECTIVE
  The study aim, based on the authors' experience in patients with prosthetic valve dysfunction, was to investigate risk factors for mortality and morbidity by analyzing preoperative, intraoperative and postoperative variables with respect to early and long-term survival.
  
  
  METHODS
  A retrospective analysis was carried out of 132 patients (47 men, 85 women; mean age 46.8 +/- 12.4 years) who presented for treatment of prosthetic valve dysfunction between December 1992 and February 2003. Two patients received thrombolytic therapy and were excluded from the statistical analysis, which comprised only operatively treated patients; four patients underwent successful surgical repair of mitral mechanical prostheses; all other patients (except two who died perioperatively) underwent prosthetic valve re-replacement (n = 124).
  
  
  RESULTS
  Overall mortality and hospital mortality rates were 15.2% and 10.6%, respectively. Postoperatively, 54 complications were seen in 42 patients (32.3%). Preoperative left ventricular end-systolic diameter (LVESD) > or = 45 mm and cardiopulmonary bypass (CPB) time > 140 min were independent risk factors for overall and in-hospital mortality. Female gender, age > 60 years and prolonged CPB time were predictors of postoperative complications. The actuarial survival rate was 87.5 +/- 0.3% at five years, and 81.7 +/- 0.4% at 10 years. A reduced left ventricular ejection fraction (LVEF) was the only independent predictor of late death and long-term survival.
  
  
  CONCLUSIONS
  Preoperative LVESD > or = 45 mm and lower LVEF were found to be independent predictors of postoperative mortality and late survival, respectively. It is possible to obtain a substantial improvement in outcome and long-term survival if a valvular reoperation can be performed with shorter CPB time and before left ventricular dysfunction has developed.
authors.affiliation: Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey. fislamoglu@hotmail.com
authors.forename: Fatih
authors.initials: F
authors.lastname: Islamoglu
authors.forename: Hikmet
authors.initials: H
authors.lastname: Iyem
authors.forename: Anil Ziya
authors.initials: AZ
authors.lastname: Apaydin
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozbaran
authors.forename: Suat
authors.initials: S
authors.lastname: Buket
authors.forename: Münevver
authors.initials: M
authors.lastname: Yüksel
authors.forename: Ali
authors.initials: A
authors.lastname: Telli
authors.forename: Isa
authors.initials: I
authors.lastname: Durmaz
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D011379:Prognosis; D011475:Prosthesis Failure; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome