title: Long-term outcomes after elective isolated mechanical aortic valve replacement in young adults.
abstract: OBJECTIVE
  The aim of this study was to determine long-term survival and clinical outcomes after elective isolated mechanical aortic valve replacement in young adults.
  
  
  METHODS
  A clinical observational study was conducted in a cohort of 450 consecutive adults less than 65 years of age who had undergone elective isolated mechanical aortic valve replacement (AVR) between 1997 and 2006. Patients who had undergone previous cardiac surgery, and those undergoing concomitant procedures or urgent surgery were excluded. Follow-up was 93.3% complete with a mean follow-up of 9.1±3.5 years. The primary end point was survival. Life table analyses were used to determine age- and gender-matched general population survival. Secondary end points were reoperation and valve-related complications.
  
  
  RESULTS
  Overall actuarial survival at 1, 5, and 10 years was 98%±1%, 95%±1%, and 87%±1%, respectively, which was lower than expected in the age- and gender-matched general population in Quebec. Actuarial freedom from prosthetic valve dysfunction was 99%±0.4%, 95%±1%, and 91%±1% at 1, 5, and 10 years, respectively. Actuarial freedom from valve reintervention was 98%±1%, 96%±1%, and 94%±1% at 1, 5 and 10 years, respectively. Actuarial survival free from reoperation at 10 years was 82%±2%. Actuarial freedom from major hemorrhage was 98%±1%, 96%±1%, and 90%±2% at 1, 5, and 10 years, respectively.
  
  
  CONCLUSIONS
  In young adults undergoing elective isolated mechanical AVR, survival remains suboptimal compared with an age- and gender-matched general population. Furthermore, there is a low but constant hazard of prosthetic valve reintervention after mechanical AVR.
authors: Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors: Ismail
authors: I
authors: Bouhout
authors: Department of Cardiac Surgery, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Canada.
authors: Louis-Mathieu
authors: LM
authors: Stevens
authors: Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors: Amine
authors: A
authors: Mazine
authors: Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors: Nancy
authors: N
authors: Poirier
authors: Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors: Raymond
authors: R
authors: Cartier
authors: Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors: Philippe
authors: P
authors: Demers
authors: Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada. Electronic address: i.elhamamsy@icm-mhi.org.
authors: Ismail
authors: I
authors: El-Hamamsy
mesh_terms: D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011792:Quebec / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome