title: Factors affecting long-term survival after aortic valve replacement.
abstract: OBJECTIVE
  To evaluate long-term outcomes of surgical aortic valve replacement (AVR) due to significant aortic stenosis (AS) and assess changes in factors affecting survival during a 10-year period in patients referred for surgery from a single centre.
  
  
  METHODS
  We evaluated 1143 patients (478 women, 665 men; mean age 61 ± 5 years) treated in the Department of Valvular Heart Disease at the Institute of Cardiology in Warsaw who were referred for AVR due to significant AS in 1998-2008 and survived the surgery and the initial 30-day postoperative period. We assessed long-term survival in relation to preoperative parameters including demographic data (age, gender), clinical variables (New York Heart Association [NYHA] class, presence of a significant coronary artery stenosis, arterial hypertension, reduced left ventricular ejection fraction [LVEF]), and operative parameters (prosthetic valve type: biological vs. mechanical, and the type of the surgery: isolated AVR vs. AVR combined with coronary artery bypass grafting).
  
  
  RESULTS
  Ten-year survival was worse in men compared to women (p = 0.001), with the effect of gender gradually decreasing after 3 years of follow-up. Factors affecting long-term survival included age (p = 0.0001) and NYHA class (p = 0.005) in women, and age (p = 0.0001), NYHA class (p = 0.0001), arterial hypertension (p = 0.01), reduced LVEF (p = 0.03), and the presence of significant coronary artery stenoses (p = 0.0001) in men. Evaluation of factors affecting 1-, 3-, 5-, and 7-year survival showed their variability mostly in men.
  
  
  CONCLUSIONS
  Long-term surgical outcomes in patients with significant AS are very good, with better survival in women compared to men, although these differences attenuated after 3 years. Factors affecting 10-year survival are different in women and men: a significant effect in women was noted only for age and preoperative NYHA class, while in men for age, NYHA class, hypertension, reduced LVEF, and the presence of significant coronary artery stenoses. During 10-year follow-up, longitudinal changes can be noted in factors affecting survival after AVR.
authors.affiliation: Department of Valvular Heart Disease, Institute of Cardiology, Warsaw, Poland. eorlowska@ikard.pl
authors.forename: Ewa
authors.initials: E
authors.lastname: Orłowska Baranowska
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Abramczuk
authors.forename: Maciej
authors.initials: M
authors.lastname: Grabowski
authors.forename: Dariusz
authors.initials: D
authors.lastname: Zakrzewski
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Miłkowska
authors.forename: Anna
authors.initials: A
authors.lastname: Galas
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Czerwińska
authors.forename: Tomasz
authors.initials: T
authors.lastname: Hryniewiecki
authors.forename: Rafał
authors.initials: R
authors.lastname: Baranowski
authors.forename: Jarosław
authors.initials: J
authors.lastname: Piskorski
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000628:therapy*; D006349:Heart Valve Diseases / Q000401:mortality* / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D013318:Stroke Volume; D015996:Survival Rate; D016896:Treatment Outcome