Determinants of long-term survival after isolated aortic valve replacement: a 10- to 17-year follow-up.
During a 9-year period from January 1965 through December 1973, we performed isolated aortic valve replacement (AVR) for aortic stenosis (AS) or aortic regurgitation (AR) in 165 patients. All operations were done during total cardiac arrest using chemical cardioplegia according to the method of Bretschneider. The prostheses used were predominantly Starr-Edwards caged ball valves. One hundred thirty-nine patients were alive 30 days after operation. The 5-, 10-, and 15-year cumulative survival rates (+/- SE) were 78 +/- 4%, 62 +/- 4%, and 29 +/- 9%, respectively. In comparison to a sex- and age-matched control population, our patients had an excess mortality in the first postoperative year and again after the twelfth year. Patients who underwent AVR in 1972 and 1973 had better results than those who had operations in 1965 through 1971 (p < 0.05); the 1972-1973 patients had 5- and 10-year survival rates of 81 +/- 5% and 72 +/- 5%, respectively. The 1-year survival rate was 91% for patients with AS and 71% for those with AR (p < 0.05). In AS patients, long-term survival was adversely affected by a history of left ventricular failure, inclusion in NYHA functional class IV, cardiothoracic index of >/= 0.56, cardiac index of < 3.0 L/min/m(2), age > 55 years, previous myocardial infarction, systemic pulse pressure of </= 40 mm Hg, mean left atrial pressure of >/= 15 mm Hg, and mean pulmonary artery pressure of >/= 24 mm Hg. In AR patients, an adverse prognosis was associated with left ventricular failure, syncope, age >/= 60 years, and NYHA class IV status. These results indicate that, in both AS and AR patients, operation should be performed early, before severely limiting symptoms and signs arise.
Lund
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Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark.