HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Gideon Cohen Tirone E. David Christopher M. Feindel Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cohen, G. Articles by Feindel, C. M. Search for Related Content PubMed PubMed Citation Articles by Cohen, G. Articles by Feindel, C. M.

J Thorac Cardiovasc Surg 1999;117:273-284
© 1999 Mosby, Inc.

SURGERY FOR ADULT CARDIOVASCULAR DISEASE

THE IMPACT OF AGE, CORONARY ARTERY DISEASE, AND CARDIAC COMORBIDITY ON LATE SURVIVAL AFTER BIOPROSTHETIC AORTIC VALVE REPLACEMENT

From the Division of Cardiovascular Surgery at The Toronto Hospital, and the University of Toronto, Toronto, Ontario, Canada.

Read at the Seventy-eighth Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 3-6, 1998.

Received for publication May 8, 1998. Revisions requested June 29, 1998. Revisions received Sept 15, 1998. Accepted for publication Oct 7, 1998. Address for reprints: Tirone E. David, MD, The Toronto Hospital, EN13-219, 200 Elizabeth St, Toronto, Ontario M5G 2C4, Canada.

Objectives: This study was designed to determine the effects of age, coronary artery disease and other cardiac comorbidities on late outcome following bioprosthetic aortic valve replacement.
Methods: Data were prospectively collected on 670 patients undergoing aortic valve replacement with the Hancock II bioprosthesis (Medtronic, Inc, Minneapolis, Minn) between 1982 and 1994. Mean patient age was 65 ± 12 years (median, 68 years; range, 18-86 years). Follow-up was 99.7% complete at 69 ± 40 months (median, 66 months; range, 0.1-168 months). Survival and freedom from reoperation were evaluated univariately by Kaplan-Meier analysis and multivariably by Cox regression.
Results: After adjustment for gender, Cox regression analysis revealed that age of 65 years or older, left ventricular dysfunction, the presence of coronary artery disease, and advanced New York Heart Association functional classification were associated with a higher risk of late death. At 12 years, survival was significantly different by Kaplan-Meier analysis for both age younger than 65 years (71% ± 4%) versus age 65 years or older (36% ± 7%; P < .0001), left ventricular function grades 3 and 4 (26% ± 13%) versus grades 1 and 2 (59% ± 4%; P < .0001), no coronary artery disease (65% ± 4%) versus coronary artery disease (35% ± 8%; P < .0001), and functional class IV (33% ± 9%) versus classes I to III (62% ± 4%; P < .0001). Only 9 patients experienced primary tissue failure, all of whom were younger than 65 years of age. At 12 years, the freedom from primary tissue failure was 84% ± 4% for those patients younger than 65 years of age, and 100% for those 65 years of age or older (P = .006).
Conclusions: Long-term survival after aortic valve replacement is highly dependent on age, coronary artery disease, functional class, and left ventricular function, although bioprosthetic durability is dependent almost solely on age. Due to increased valve durability in patients who are 65 years of age or older, the Hancock II bioprosthesis may be an ideal aortic valve substitute in this age group. In patients who are younger than 65 years of age with advanced functional class, impaired left ventricular function, and coronary artery disease, this valve may also be used with a low probability of primary tissue failure. Patients without additional cardiac comorbidity may outlive their bioprosthetic valve, leading to reoperation.

This article has been cited by other articles:

				N. D. Desai and G. T. Christakis Bioprosthetic Aortic Valve Replacement: Stented Pericardial and Porcine Valves Card. Surg. Adult, January 1, 2008; 3(2008): 857 - 894. [Full Text]

				Y. S. Tjang, Y. van Hees, R. Korfer, D. E. Grobbee, and G. J.M.G. van der Heijden Predictors of mortality after aortic valve replacement Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 469 - 474. [Abstract] [Full Text] [PDF]

				F. B. Vanky, E. Hakanson, and R. Svedjeholm Long-Term Consequences of Postoperative Heart Failure After Surgery for Aortic Stenosis Compared With Coronary Surgery Ann. Thorac. Surg., June 1, 2007; 83(6): 2036 - 2043. [Abstract] [Full Text] [PDF]

				L. Osman, M. H. Yacoub, N. Latif, M. Amrani, and A. H. Chester Role of Human Valve Interstitial Cells in Valve Calcification and Their Response to Atorvastatin Circulation, July 4, 2006; 114(1_suppl): I-547 - I-552. [Abstract] [Full Text] [PDF]

				V. Chan, W.R.E. Jamieson, E. Germann, F. Chan, R.T. Miyagishima, L.H. Burr, M.T. Janusz, H. Ling, and G.J. Fradet Performance of bioprostheses and mechanical prostheses assessed by composites of valve-related complications to 15 years after aortic valve replacement J. Thorac. Cardiovasc. Surg., June 1, 2006; 131(6): 1267 - 1273. [Abstract] [Full Text] [PDF]

				P. M. Davierwala, M. A. Borger, T. E. David, V. Rao, M. Maganti, and T. M. Yau Reoperation is not an independent predictor of mortality during aortic valve surgery J. Thorac. Cardiovasc. Surg., February 1, 2006; 131(2): 329 - 335. [Abstract] [Full Text] [PDF]

				N. D. Desai, O. Merin, G. N. Cohen, J. Herman, S. Mobilos, J. Y. Sever, S. E. Fremes, B. S. Goldman, and G. T. Christakis Long-Term Results of Aortic Valve Replacement With the St. Jude Toronto Stentless Porcine Valve Ann. Thorac. Surg., December 1, 2004; 78(6): 2076 - 2083. [Abstract] [Full Text] [PDF]

				T. E. David, J. Ivanov, S. Armstrong, and H. Rakowski Late outcomes of mitral valve repair for floppy valves: Implications for asymptomatic patients J. Thorac. Cardiovasc. Surg., May 1, 2003; 125(5): 1143 - 1152. [Abstract] [Full Text] [PDF]

				N. D. Desai and G. T. Christakis Stented Mechanical/Bioprosthetic Aortic Valve Replacement Card. Surg. Adult, January 1, 2003; 2(2003): 825 - 856. [Full Text]

				C. W. Akins, A. D. Hilgenberg, G. J. Vlahakes, T. E. MacGillivray, D. F. Torchiana, and J. C. Madsen Results of bioprosthetic versus mechanical aortic valve replacement performed with concomitant coronary artery bypass grafting Ann. Thorac. Surg., October 1, 2002; 74(4): 1098 - 1106. [Abstract] [Full Text] [PDF]

				P. Groves VALVE DISEASE: Surgery of valve disease: late results and late complications Heart, December 1, 2001; 86(6): 715 - 721. [Full Text] [PDF]

				G. Ismeno, A. Renzulli, M. De Feo, A. Della Corte, F. E. Covino, and M. Cotrufo Standard versus hemodynamic plus 19-mm St Jude Medical aortic valves J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 723 - 728. [Abstract] [Full Text] [PDF]

				T. E. David, J. Ivanov, S. Armstrong, C. M. Feindel, and G. Cohen Late results of heart valve replacement with the Hancock II bioprosthesis J. Thorac. Cardiovasc. Surg., February 1, 2001; 121(2): 0268 - 278. [Abstract] [Full Text] [PDF]

				H.-J. Priebe The aged cardiovascular risk patient Br. J. Anaesth., November 1, 2000; 85(5): 763 - 778. [Abstract] [Full Text] [PDF]

				C. Schmidtke, J. F. M. Bechtel, A. Noetzold, and H.-H. Sievers Up to seven years of experience with the Ross procedure in patients >60 years of age J. Am. Coll. Cardiol., October 1, 2000; 36(4): 1173 - 1177. [Abstract] [Full Text] [PDF]