Copyright © 2000 by the European Society of Cardiology.
Long-term follow-up of morbidity and mortality after aortic valve replacement with a mechanical valve prosthesis
a Departments of Cardiology, University Hospital, Uppsala, Sweden
d Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, Sweden
c Department of Thoracic and Cardiovascular Surgery, University Hospital, Lund, Sweden
b Department of Statistics, University of Uppsala, Uppsala, Sweden
revised February 24, 2000; accepted March 21, 2000
Abstract
Aims The aim of this study was to determine the incidence of valve-related complications in patients with a mechanical aortic valve prosthesis and to identify risk factors for an adverse outcome.
Methods and Results In the 424 patients, event-free survival rates 5 and 10 years after aortic valve replacement were 62% and 37%, respectively. The linearized incidence of thromboembolic events was 4·4% per patient-year, and of anticoagulant-related haemorrhage 8·5% per patient-year. Advanced NYHA functional class, atrial fibrillation, pure aortic regurgitation and thromboembolism prior to surgery decreased event-free survival. A history of pre-operative thromboembolism increased the risk for a first embolic event after aortic valve replacement (relative hazard [RH] 3·2), but was even more strongly associated with the risk for repeated events (
2 events, RH 5·4). After each thromboembolic episode that occurred, the risk for a subsequent one was increased. The risk for at least one, and up to three or more haemorrhages was increased in patients with a pre-operative history of bleeding (RH 3·3–5·1) and of atrial fibrillation (RH 1·8–3·9). The risk for a subsequent event was increased by a history of repeated haemorrhages, a short interval since previous bleeding, and high age.
Conclusions There were few factors strongly related to valve related morbidity. However, previous bleedings and previous thromboembolism were powerful risk factors for repeated events.
Key Words: Heart valve replacement, aortic valve, mechanical valve prosthesis, Björk-Shiley Monostrut, Edwards Duromedics, long-term follow-up, prospective
f1 Correspondence: Per Kvidal, MD, Department of Cardiology, University Hospital, S-751 85 Uppsala, Sweden.
References
- Lund O. Preoperative risk evaluation and stratification of long-term survival after valve replacement for aortic stenosis. Reasons for earlier operative intervention. Circulation. 1990;82:124–139
[Abstract/Free Full Text] - Klodas E, Enriguez-Sarano M, Tajik AJ, Mullany CJ, Bailey KR, Seward JB. Optimizing timing of surgical correction in patients with severe aortic regurgitation: role of symptoms. J Am Coll Cardiol. 1997;30:746–752[Abstract]
- Bonow RO. Chronic aortic regurgitation. Role of medical therapy and optimal timing for surgery. Cardiol Clin. 1998;16:449–461[CrossRef][Medline]
- Pellikka PA, Nishimura RA, Bailey KR, Tajik AJ. The natural history of adults with asymptomatic, hemodynamically significant aortic stenosis. J Am Coll Cardiol. 1990;15:1012–1017[Abstract]
- Verheul HA, van den Brink RBA, Bouma BJ. Analysis of risk factors for excess mortality after aortic valve replacement. J Am Coll Cardiol. 1995;26:1280–1286[Abstract]
- Carabello BA. Timing of valve replacement in aortic stenosis. Moving closer to perfection. Circulation. 1997;95:2241–2243
[Free Full Text] - St
hle E, Kvidal P, Nyström SO, Bergström R. Long-term relative survival after primary heart valve replacement. Eur J Cardiothorac Surg. 1997;11:81–91[Abstract]
- Akins CW. Results with mechanical cardiac valvular prostheses. Ann Thorac Surg. 1995;60:1836–1844
[Abstract/Free Full Text] - Horstkotte D, Schulte H, Bircks W, Strauer B. Unexpected findings concerning thromboembolic complications and anticoagulation after complete 10 year follow-up of patients with St. Jude Medical Prostheses. J Heart Valve Dis. 1993;2:291–301[Medline]
- Miller DC, Oyer PE, Mitchell RS. Performance characteristics of the Starr-Edwards Model 1260 aortic valve prosthesis beyond ten years. J Thorac Cardiovasc Surg. 1984;88:193–207[Abstract]
- Kuntze CEE, Blackstone EH, Ebels T. Thromboembolism and mechanical heart valves: a randomized study revisited. Ann Thorac Surg. 1988;66:101–107
- Edmunds LH Jr, Clark RE, Cohn LH, Grunkemeier GL, Miller DC, Weisel RD. Guidelines for reporting morbidity and mortality after cardiac valvular operations. Eur J Cardiothorac Surg. 1996;10:812–816[Abstract]
- Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic research: principles and quantitative methods. Belmont: Wadsworth Inc; 1982.
- Cox DR. Regression models and life-tables. JR Statist Soc B. 1972;34:187–220
- Blackstone EH. Methods and limitations of follow-up assessment of replacement heart valves. Bodnar E, Frater RWM. Replacement Cardiac Valves. 1991. p. 391–434
- Wade OL, Bishop JM. Cardiac output and regional blood flow. Oxford: Blackwell Scientific Publ; 1962. p. 112
- Podesser BK, Khuenl-Brady G, Eigenbauer E. Long-term results of heart valve replacement with the Edwards Duromedics bileaflet prosthesis: a prospective ten-year clinical follow-up. J Thorac Cardiovasc Surg. 1998;115:1121–1129
[Abstract/Free Full Text] - Fiane AE, Geiran OR, Svennevig JL. Up to eight years' follow-up of 997 patients receiving the Carbomedics prosthetic heart valve. Ann Thorac Surg. 1998;66:443–448
[Abstract/Free Full Text] - Horstkotte D. Results with mechanical cardiac valvular prostheses. Ann Thorac Surg. 1996;62:1565–1567
[Free Full Text] - Acar J, Enriquez-Sarano M, Farah R, Kassab R, Tubiana P, Roger V. Recurrent systemic embolic events with valve prosthesis. Eur Heart J. 1984;5:33–38
- Farah E, Enriquez-Sarano M, Vahanian A. Thromboembolic and haemorrhagic risk in mechanical and biological aortic prostheses. Eur Heart J. 1984;5:43–47
[Abstract/Free Full Text] - Turpie AGG, Gunstensen J, Hirsh J, Gent M. Randomisierter vergleich zweier dosierungsstärken zur oralen antikoagulantientherapie nach bioklappenersatz. Lancet (deutsche ausgabe). 1988;2:587–590
- Saour JN, Sieck JO, Mamo LAR, Gallus AS. Trial of different intensities of anticoagulation in patients with prosthetic heart valves. N Engl J Med. 1990;322:428–432[Abstract]
- Horstkotte D, Schulte HD, Bircks W, Strauer BE. Lower intensity anticoagulation therapy results in lower complication rates with the St. Jude Medical prosthesis. J Cardiovasc Surg. 1994;107:1136–1145
- Bonow RO, Carabello B, de Leon AC Jr. ACC/AHA guidelines for management of patients with valvular heart disease: a report of the American College of Cardiology/ American Heart Association Task Force on Practise Guidelines (Committee on Management of Patients With Valvular Heart Disease). J Am Coll Cardiol. 1998;32:1486–1588
[Free Full Text] - Gohlke-Barwolt C, Acar J, Oakley C. Guidelines for prevention of thromboembolic events in valvular heart disease. Study Group of the Working Group on Valvular Heart Disease of the European Society of Cardiology. Eur Heart J. 1995;16:1320–1330
[Free Full Text] - Loewen P, Sunderji R, Gin K. The efficacy and safety of combination warfarin and ASA therapy: a systematic review of the literature and update of guidelines. Can J Cardiol. 1998;14:717–726[Web of Science][Medline]
- Turpie AG, Gent M, Laupacis A. A comparison of aspirin with placebo in patients treated with warfarin after heart-valve replacement. N Engl J Med. 1993;329:524–529
[Abstract/Free Full Text] - Pouleur H, Buyse M. Effects of dipyridamole in combination with anticoagulant therapy on survival and thromboembolic events in patients with prosthetic heart valves. A meta-analysis of the randomized trials. J Thorac Cardiovasc Surg. 1995;110:463–472
[Abstract/Free Full Text] - Stein PD, Alpert JS, Dalen JE, Horstkotte D, Turpie AG. Antithrombotic therapy in patients with mechanical and biological prosthetic heart valves. Chest. 1998;114:S602–610
[Free Full Text] - Harenberg J, Huhle G, Piazolo L, Giese C, Heene DL. Long-term anticoagulation of outpatients with adverse events to oral anticoagulants using low-molecular-weight heparin. Semin Thromb Hemost. 1997;23:167–172[Medline]
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