Aortic valve replacement and long-term prognosis.
OBJECTIVE
We assessed the long-term risk of mortality associated with mechanical and biological aortic valve replacement (AVR).


METHODS
We reviewed articles published during the last decade, with emphasis on large series reporting mortality data and follow up of 5 years or longer. The latest editions of textbooks on cardiology and cardiac surgery were also reviewed. We used mortality analysis methodology, comparing the observed mortality in these series to the expected mortality calculated from country specific life tables, to calculate the risk of mortality expressed as the mortality ratio (MR), values above 100% traducing the excess risk of mortality compared to the general population.


RESULTS
After AVR, the MR varied from 120% to 350% for mechanical valve prostheses, and from 100% to 300 for bioprosthetic valves according to age at surgery. MR above 400% was associated with an AVR before the age of 50 years. No significant difference in the MR over age 50 years was found between mechanical and biological AVR. Independent prognostic factors after AVR are age at surgery, New York Heart Association (NYHA) functional class at time of surgery, left ventricular ejection fraction (LVEF), atrial fibrillation, and type and severity of valvular lesion.


CONCLUSIONS
No difference was found for excess mortality between mechanical and biological AVR. Under the age of 50 years, higher mortality was associated with both mechanical and bioprosthetic AVR.
Naslafkih
Abdelouahed
A
Université de Montréal, Insurance Medicine Program, CP 6128 Succ, Centre-ville, Montreal, QC, Canada H3C 3J7.
François
Sestier
S
Fix
Jean-Marc
JM
Khoury
Abdelnour
A
D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020379:Risk Adjustment; D017741:Survivors; D014481:United States / Q000453:epidemiology