Copyright © 1997 by the European Society of Cardiology.
© 1997 The European Society of Cardiology
25 years of aortic valve replacement using mechanical valves
Risk factors for early and late mortality
*Department of Cardiothoracic Surgery, University Hospital Dijkzigt Rotterdam, The Netherlands
Department of Public Health, Erasmus University Rotterdam (Center for Clinical Decision Sciences) Rotterdam, The Netherlands
revised 3 September 1996; accepted 6 September 1996.
Correspondence: R. B. Hokken, Department of Cardiothoracic Surgery, BD 156, Dijkzigt University Hospital, 3015 GD Rotterdam, The Netherlands
Abstract
This study describes the changes that have taken place in patient characteristics in 25 years of aortic valve replacement using mechanical valves, and looks for risk factors for early and late mortality. During this period, 1449 mechanical valves were implanted. Overall early mortality (<30 days) was 5·3% and for aortic valve replacement without concomitant procedures 3·9%. Overall survival rates at 5, 10 and 15 years were 80%, 63% and 49%, respectively. Despite an increased proportion of higher risk patients (older age, more reoperations, more concomitant coronary bypass surgery) survival rates improved throughout the study period. Early mortality was related to an early year of operation, urgency, reoperation and concomitant surgery to the tricuspid valve or ascending aorta. Late mortality was higher for patients of older age, with an early year of operation, male gender, concomitant coronary bypass surgery, mitral valve surgery or replacement of the ascending aorta. Aortic regurgitation did not have a major influence on early nor late mortality. The improvement in early and late mortality in more recent years was largely the result of the introduction of cardioplegia. A changing, non-proportional effect was observed for several risk factors during the follow-up period. This study illustrates the changes and improvements in medical care that have taken place in patients requiring aortic valve replacement.
Key Words: Aortic valve • mechanical prosthesis • Poisson regression analysis • cardioplegia
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