Long-term outcomes of valve replacement with modern prostheses in young adults.
OBJECTIVE
To examine the multiple impacts of valve replacement on the lives of young adults.


METHODS
Patients (N=500) between age 18 and 50 who had aortic valve replacement (AVR) and/or mitral valve replacement (MVR) with contemporary prostheses were followed annually. Events, functional status, and quality of life were examined with regression models.


RESULTS
Median follow-up was 7.1+/-5.3 years (maximum 26.7 years). Five, 10, and 15-year survival was 92.7+/-1.7, 88.3+/-2.4 and 80.1+/-4.7% after AVR, and 93.1+/-2.3, 79.5+/-4.3 and 71.5+/-5.4% after MVR, respectively. Survival decreased with concomitant coronary disease (hazard ratio (HR): 4.5) and preoperative LV grade (HR: 2.0/grade increase) in AVR patients, and with atrial fibrillation (HR: 5.5), coronary disease (HR: 5.7), preoperative left atrial diameter (HR: 3.0/cm increase) and NYHA class (HR: 2.1/class increase) in MVR patients. Despite reoperation, late survival was equivalent between bioprostheses and mechanical valves in both implant positions. The ten-year cumulative incidence of embolic stroke was 6.3+/-2.4% for mechanical AVR patients, 6.4+/-2.9% for bioprosthetic AVR patients, 12.7+/-3.9% for mechanical MVR patients, and 3.1+/-3.1% for bioprosthetic MVR patients. Atrial fibrillation (HR: 2.8) and smoking (HR: 4.0) were risk factors for stroke in MVR patients. In AVR patients, SF-12 physical scores, freedom from recurrent heart failure, and freedom from disability were significantly higher in bioprosthetic than mechanical valve patients. Career or income limitations were more often subjectively linked to a mechanical prosthesis in both implant positions.


CONCLUSIONS
Late outcomes of modern prosthetic valves in young adults remain suboptimal. Bioprostheses deserve consideration in the aortic position, as mechanical valves are associated with lower physical capacity, a higher prevalence of disability, and poorer disease perception. Early surgical referral and atrial fibrillation surgery may improve survival after MVR.
Ruel
Marc
M
Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin Street, Suite 3403, Ottawa, Ontario, Canada K1Y 4W7. mruel@ottawaheart.ca
Kulik
Alexander
A
Lam
Buu K
BK
Rubens
Fraser D
FD
Hendry
Paul J
PJ
Masters
Roy G
RG
Bédard
Pierre
P
Mesana
Thierry G
TG
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000925:Anticoagulants / Q000008:administration & dosage; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006349:Heart Valve Diseases / Q000534:rehabilitation / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects* / Q000523:psychology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000523:psychology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011379:Prognosis; D011475:Prosthesis Failure; D011788:Quality of Life; D012086:Reoperation; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome
D000925:Anticoagulants