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Ann Thorac Surg 1991;52:270-275
© 1991 The Society of Thoracic Surgeons

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Articles

Survival and valve failure after aortic valve replacement

Division of Cardiovascular Surgery, the Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada

Accepted for publication April 16, 1991.

^_* Address reprint requests to Dr Weisel, Cardiovascular Surgery, Toronto General Hospital, EN 14–215, 200 Elizabeth St, Toronto, Ont, M5V 1L7, Canada.

A prospective evaluation of 412 consecutive patients undergoing isolated aortic valve replacement between January 1982 and December 1985 was performed in an attempt to identify the determinants of survival and valve failure. A variety of valves were inserted to permit a prospective evaluation of alternative valves including: Björk-Shiley mechanical (n = 37), Ionescu-Shiley pericardial (n = 261), Hancock pericardial (n = 78), and Carpentier-Edwards porcine (n = 36). Thirteen patients died in the hospital (3.2%) and 47 patients died in the follow-up period producing an actuarial survival of 81% ± 3% at 48 months. Survival was independently predicted by advancing age, preoperative New York Heart Association functional class, and the presence of endocarditis (p < 0.05 by Cox regression analysis). The majority of patients were symptomatically improved (New York Heart Association class I or II: 21% preoperative, 88% postoperative). Freedom from structural valve dysfunction, prosthetic valve endocarditis, and reoperation for valve-related complications were 95% ± 2%, 95% ± 2%, and 92% ± 2% at 48 months, respectively. These valve-related complications occurred more frequently in younger patients and in those with a Hancock pericardial valve (freedom from structural valve dysfunction, 89% ± 5%; prosthetic valve endocarditis, 84% ± 9%; reoperation, 73% ± 10%; p < 0.05 by Cox regression). Freedom from thromboembolism was 88% ± 2% at 48 months; it was significantly lower in patients with a preoperative thromboembolic event and was not influenced by the type of prosthesis inserted. Freedom from anticoagulant-related hemorrhage was 85% ± 8% at 48 months and was not influenced by any preoperative factors. Aortic valve replacement resulted in excellent symptomatic improvement, Postoperatively, older patients died whereas younger patients suffered valve-related complications. The Hancock pericardial valve had an unacceptably high incidence of premature valve failure.

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