Impaired left ventricular function, severe prosthesis-patient mismatch, and increased aortic cross-clamp time independently predicted decreased long-term survival over 25.1 years of follow-up.
Cohort (n=673)
What are the predictors of long-term survival and major bleeding in patients undergoing aortic valve replacement?
Over a 25-year follow-up after aortic valve replacement, impaired LV function, severe prosthesis-patient mismatch, and prolonged cross-clamp time predicted mortality, while mechanical valves increased bleeding risk even in patients under 60.
BACKGROUND: Studies on very long-term outcomes after aortic valve replacement are sparse. METHODS: In this retrospective cohort study, long-term outcomes during 25.1 ± 2.8 years of follow-up were determined in 673 patients who underwent aortic valve replacement with or without concomitant coronary artery bypass surgery for severe aortic stenosis and/or regurgitation. Independent predictors of decreased long-term survival were determined. Cumulative incidence rates of major adverse events in patients with a mechanical versus those with a biologic prosthesis were assessed, as well as of major bleeding events in patients with a mechanical prosthesis under the age of 60 versus those above the age of 60. RESULTS: Impaired left ventricular function, severe prosthesis-patient mismatch, and increased aortic cross-clamp time were independent predictors of decreased long-term survival. Left ventricular hypertrophy, a mechanical or biologic prosthesis, increased cardiopulmonary bypass time, new-onset postoperative atrial fibrillation, and the presence of symptoms did not independently predict decreased long-term survival. The risk of major bleeding events was higher in patients with a mechanical in comparison with those with a biologic prosthesis. Younger age (under 60 years) did not protect patients with a mechanical prosthesis against major bleeding events. CONCLUSIONS: Very long-term outcome data are invaluable for careful decision-making on aortic valve replacement.
Swinkels et al. (Tue,) conducted a cohort in severe aortic stenosis and/or regurgitation (n=673). Aortic valve replacement (mechanical vs biologic prosthesis) was evaluated on Long-term survival. Impaired left ventricular function, severe prosthesis-patient mismatch, and increased aortic cross-clamp time independently predicted decreased long-term survival over 25.1 years of follow-up.
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