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The Journal of Thoracic and Cardiovascular Surgery, Vol 97, 675-694, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
BW Lytle, DM Cosgrove, PC Taylor, M Goormastic, RW Stewart, LA Golding, CC Gill and FD Loop
A total of 1689 consecutive patients underwent isolated aortic valve
replacement at the Cleveland Clinic Foundation from 1972 through 1986.
There were 57 (3.4%) in-hospital deaths. Multivariate analysis identified
advanced age (p = 0.0014), preoperative blood urea nitrogen level greater
than 25 mg/100 ml (p = 0.008), New York Heart Association function class (p
= 0.015), and preoperative atrial fibrillation (p = 0.04) as independent
variables associated with increased in-hospital mortality and the use of
cardioplegia for myocardial protection (p = 0.006) as a factor decreasing
mortality. Follow-up documented survival rates of 85% and 66% and
event-free survival rates of 71% and 43% at 5 and 10 postoperative years,
respectively. Advanced age, moderate or severe impairment of left
ventricular function, coronary artery disease, and preoperative blood urea
nitrogen level greater than 25 mg/100 ml were associated with decreased
late survival and event-free survival (all p less than 0.05). Patients with
bioprostheses had better survival (p = 0.003) and event-free survival (p =
0.0007) rates than patients with mechanical valves. Patients with
bioprostheses had superior results only if not receiving warfarin, and they
experienced more reoperations and endocarditis; those with mechanical
prostheses had more strokes, myocardial infarctions, bleeding
complications, and thromboembolic events. Analysis of patients grouped
according to age at operation showed that bioprostheses were associated
with improved survival and event-free survival for patients 40 years older
or older. Younger patients experienced more reoperations and episodes of
endocarditis, and older patients more thromboembolic complications. We
conclude that 10-year results after isolated aortic valve replacement are
influenced by both patient-related and management-related variables, and
the impact of these factors is different for patients of different ages.
ARTICLES
Primary isolated aortic valve replacement. Early and late results
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio 44195.
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F. Santini, C. Dyke, S. Edwards, G. Stavri, M. Feccia, H. Khan, E. Birks, and M. H. Yacoub PULMONARY AUTOGRAFT VERSUS HOMOGRAFT REPLACEMENT OF THE AORTIC VALVE: A PROSPECTIVE RANDOMIZED TRIAL J. Thorac. Cardiovasc. Surg., May 1, 1997; 113(5): 894 - 900. [Abstract] [Full Text]
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T. A. Orszulak, H. V. Schaff, F. J. Puga, G. K. Danielson, C. J. Mullany, B. J. Anderson, and D. M. Ilstrup Event Status of the Starr-Edwards Aortic Valve to 20 Years: A Benchmark for Comparison Ann. Thorac. Surg., March 1, 1997; 63(3): 620 - 626. [Abstract] [Full Text]
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J. I. Fann, D. C. Miller, KathleenA. Moore, R. S. Mitchell, P. E. Oyer, E. B. Stinson, R. C. Robbins, B. A. Reitz, and N. E. Shumway Twenty-Year Clinical Experience With Porcine Bioprostheses Ann. Thorac. Surg., November 1, 1996; 62(5): 1301 - 1311. [Abstract] [Full Text]
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G. T. Christakis, C. D. Joyner, C. D. Morgan, S. E. Fremes, K. J. Buth, J. Y. Sever, V. Rao, K. P. Panagiotopoulos, P. M. Murphy, and B. S. Goldman Left Ventricular Mass Regression Early After Aortic Valve Replacement Ann. Thorac. Surg., October 1, 1996; 62(4): 1084 - 1089. [Abstract] [Full Text]
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 A. Belboul, N. Al-Khaja, A. El-Gatit, Bo Liu, D. Roberts, and G. William-Olsson Late Improvement in Blood Cell Filterability and Cardiac Function Following Open Heart Surgery Vascular and Endovascular Surgery, September 1, 1992; 26(7): 543 - 551. [Abstract] [PDF]
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