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• W4293362086 abstract "Aortic valve replacement was performed in 912 consecutive patients from January, 1972, to January, 1983. The 616 male and 296 female patients, whose ages ranged from 16 to 95 years (mean 60.6 years and median 63 years), received 663 bioprosthetic valves and 249 tilting disc valves. A higher incidence of Functional Class IV heart disease and ascending aortic aneurysms was noted in the group receiving the tilting disc valve. Six hundred fifty-seven patients had primarily aortic stenosis and 255 had primarily aortic regurgitation. Associated procedures were done in 308 patients (33%): 233 had coronary bypass grafting, 46 had replacement of ascending aortic aneurysms, and 29 had miscellaneous procedures. The overall operative mortality was 6.4 % (59/912). The operative mortality was 4.5 % (29/640) for isolated aortic valve replacement, 4.2% (21/233) for valve replacement plus coronary bypass, and 17% (8/46) for valve replacement plus replacement of an ascending aortic aneurysm. The mortality was 4.2% (20/663) for the group receiving bioprostheses and 12.4% (31/249) for those receiving tilting disc valves. The operative mortality for 1983 for all aortic valve replacement procedures was 2.1%; for isolated valve replacement, 1%; for valve replacement plus coronary bypass, 4.4%; and for valve replacement plus aortic aneurysm replacement, 0 %. The long-term follow-up was analyzed as of Jan. 1,1984, so that there was a minimum follow-up of 12 months (mean 55 months and median 51 months). The actuarial survival rate at 108 months for all patients was 67% ± 2%; for valve replacement alone, 71 % ± 3%; for valve replacement plus coronary bypass, 58% ± 7%; for valve replacement plus ascending aortic aneurysm replacement, 45% ± 10%; for aortic stenosis, 70% ± 3%; for aortic regurgitation, 61% ± 4%; for Functional Classes I to III, 77% ± 3%; for Class IV, 53% ± 4%; for age less than 63 years, 75 % ± 3 %; and for age greater than 63 years, 57 % ± 4 %. At 108 months, the probability of freedom from thromboembolism was 85% ±3% after bioprosthetic valve replacement and 83% ±3% after replacement with a tilting disc valve (p = NS). The probability of freedom from hemorrhage at 108 months was 98.6% ±7% for the bioprosthetic valve group and 89% ±2% for the tilting disc valve group (p < 0.001). The valve thrombosis rate was 0.34% per patient-year for the tilting disc valves and 0.07% per patient-year for the bioprostheses. The incidence of primary valve failure was 0.79% per patient-year for the bioprostheses; none of the tilting disc valves failed (p < 0.0001). The incidence of endocarditis was 0.55% per patient-year with the bioprostheses and 0.09% per patient-year with the tilting disc valves (p = 0.006). Late mortality was significantly higher in the group receiving tilting disc valves (6.02% versus 3.64% per patient-year, p = 0.003). The overall operative risk for aortic valve replacement is now about 5 %, 1 % to 2 % for isolated aortic valve replacement Late survival reflects the preoperative functional classification and associated cardiovascular disease. Thromboembolism, valve thrombosis, and anticoagulant-related hemorrhage are the major risk factors for tilting disc valves, whereas valve failure, primary or infectious, is the major risk factor for bioprosthetic valves." @default.
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• W4293362086 date "1984-11-01" @default.
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• W4293362086 title "Early and late risk of aortic valve replacement" @default.
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• W4293362086 doi "https://doi.org/10.1016/s0022-5223(19)35437-6" @default.
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