Early and Mid-term Evaluation of Aortic Valve Replacement (original) (raw)
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Nine-year routine clinical experience of aortic valve replacement with ATS mechanical valves
The Journal of heart valve disease, 2008
The study aim was to update the authors' experience with aortic valve replacement (AVR) using the ATS mechanical prosthesis in terms of early and long-term outcome in routine practice. This retrospective analysis was extracted from clinical data available between April 1996 and February 2005, of AVR with the ATS Medical prosthesis in 510 consecutive patients (345 men, 165 women; mean age 62 +/- 12 years), of whom 296 underwent isolated AVR (iAVR). Concomitant surgical procedures included coronary artery bypass grafting (AVR+CABG, n = 47), mitral valve procedure (AVR+MVP, n = 59), ascending aortic replacement (AVR+AAR, n = 74) and other procedures (AVR+Miscellaneous, n = 34). Early and late morbidity/mortality were analyzed for the entire group in case of emergency surgery, preoperative low left ventricular ejection fraction (LVEF <50%) and in elderly people (age > or = 70 years). The overall 30-day mortality was 7.2% (iAVR 4.7%; AVR+CABG 4%; AVR+MVP 8.5%; AVR+AAR 2.9%; AVR...
Aortic Valve Replacement: A 9-Year Experience
The Annals of Thoracic Surgery, 1980
Experience with aortic valve replacement over a 9-year period is reviewed. Hospital mortality was 5.0°/0, with an additional late mortality of 15.0% during a mean follow-up period of 4.3 years. There was a 7.5% mortality among the 93 patients who were operated on using direct coronary perfusion. There were no early deaths among the 48 patients operated on using cold cardioplegic arrest. Paravalvular leaks developed in 20 patients, and 9 had reoperation. There were no early deaths following elective reoperations for prosthetic valve dysfunction, but urgent reoperation was associated with a 40% mortality. Eighty percent of all patients are still alive at a maximum follow-up of 9 years. Eighty-six percent of the survivors who were in New York Heart Association Functional Class 111 or IV before operation are now in Class I or 11. Hypothermic cardioplegic arrest was found to be preferable to coronary perfusion as a method of myocardial protection during aortic valve replacement. Patients with paravalvular leaks who have a history of left ventricular failure prior to aortic valve replacement should be considered candidates for early elective reoperation, owing to the significantly greater mortality associated with urgent reoperation.
Surgical aortic valve replacement
Cardiology International
Aortic valve replacement (AVR) with artificial valves was first attempted in the 1950s. Since then a number of mechanical heart valves and bioprostheses have been developed for the treatment of valvular heart disease. Current options for AVR include mechanical valves, stented biologic valve prostheses, stentless biologic valve prostheses and, less frequently, homografts and autografts. The ideal valve substitute should mimic the characteristics of a normal native valve. In particular, it should have excellent haemodynamics, long durability, high thromboresistance and excellent implantability. Unfortunately, this ideal valve substitute does not exist, and each of the currently available prosthetic valves has inherent limitations. Bileaflet mechanical valves are extremely durable, with excellent haemodynamics and minimal thrombogenicity. Patients require anticoagulation mostly based on vitamin K antagonists with their associated complications. Bioprosthetic valves usually require only...
Results of prosthetic valve replacement for aortic stenosis
Indian Journal of Thoracic and Cardiovascular Surgery, 2002
Background: Aortic valve replacement with mechanical valves is associated with a small but constant risk of valve thrombosis and thromboembolic and hemorrhagic complications. The surgical outcome of patients with Aortic Stenosis who had aortic valve replacement with mechanical valves is reported here. Methods: Between January 1990 and October 1999, 275 patients underwent prosthetic valve replacement for isolated aortic stenosis. The age ranged between 13 years and 75 years and 230 were males. The cause of aortic stenosis was rheumatic in 185 patients (67.3%), followed by bicuspid aortic valve in 75 patients (27.3%) and degenerative in 15 patients (5.4%). Results: The early mortality was 1.5%. The follow up was 96% complete and ranged from 1 to 104 months (mean 54±24.5months). Six patients (2.2%) developed prosthetic valve endocarditis. Paravalvular leak occurred in 3 (0.9%) patients. Valve thrombosis occurred in 10 patients (1.0% per patient year). The actuarial survival was 81±7% at 5 years and 64±13% at 8 years. Event free survival was 40±14% at 8 years. Conclusion: With current operative techniques and myocardial preservation aortic stenosis patients are at low risk for surgery. However, long term survival is limited due to prosthesis related complications.
The Journal of Thoracic and Cardiovascular Surgery, 2011
Objectives: Aortic valve replacement is accepted as a standard treatment for aortic stenosis and regurgitation. To help plan the national requirement for conventional and catheter-based procedures, we have analyzed the Society for Cardiothoracic Surgery in Great Britain and Ireland audit database to look at changes in practice over time. Methods: All patients undergoing conventional aortic valve replacement with or without coronary artery surgery from April 2004 to March 2009 were included. The main outcome measures were changes in the number, characteristics, operative details, and in-hospital mortality. We have looked particularly at trends and outcomes in elderly and high-risk patients (EuroSCORE of 10 or more) who may now be considered for percutaneous aortic valve insertion. Results: A total of 41,227 patients underwent aortic valve surgery over 5 years with an in-hospital mortality of 4.1%. The annual number increased from 7396 in 2004-2005 to 9333 in 2008-2009, with significant increases (P<.0005) in mean age (68.8-70.2 years), the proportion of patients with aortic stenosis (62.4%-65.1%), octogenarians (13.6%-18.4%), high-risk patients (24.6%-27.7%), and those receiving biological valves (65.4%-77.8%). The incidence of permanent cerebrovascular accident was 1.2% and 1.0% in patients having only an aortic valve replacement. The dialysis rate was 4.5% and the reoperation rate for bleeding was 6.6%. Overall mortality decreased from 4.4% in 2004-2005 to 3.7% in 2008-2009. Survival to a mean follow-up of 2.5 years was 89%. Conclusions: We have seen a large increase in annual volume of aortic valve replacements, with more patients undergoing surgery for aortic stenosis and an increase in surgery in the elderly and high-risk patients.
Aortic Valve Replacement: Are We Spoiled for Choice?
Seminars in Thoracic and Cardiovascular Surgery, 2017
Management of aortic valve disease and in particular aortic valve stenosis has evolved through the course of time from medical management and balloon valvuloplasty to the presumed gold standard surgical intervention. However, with the advent of surgical innovation, intra and postoperative patients monitoring, understanding of hemodynamic dysfunction and choices of prosthesis, conventional surgical aortic valve replacements currently being challenged in particular in moderate and high risk patients. Although the long-term results and survival are not robustly available, the durability of the new prosthesis, repair and the freedom from reoperation remain debatable. In this review, we aim to highlight the surgical innovation attained, choices of aortic Page 1 of 23 valve prosthesis and also dwell on the current evidence, practice and trend steered to managing patients with aortic valve stenosis. Central Message: In this review, we aim to highlight the surgical innovation attained, choices of aortic valve prosthesis and also dwell on the current evidence, practice and trend steered to managing patients with aortic valve stenosis.
Prosthetic Valve Type for Patients Undergoing Aortic Valve Replacement: A Decision Analysis
2010
Background. In two large, randomized, clinical trials long-term survival after aortic valve replacement (AVR) was similar for patients receiving tissue and mechanical aortic heart valve prostheses. Higher bleeding rates among patients with mechanical valves, who must re- ceive permanent oral anticoagulation to prevent throm- boembolism, were offset by higher reoperation rates for valve degeneration among patients with tissue valves. Because
Aortic Valve Replacement in Patients with Previous Cardiac Surgery
Journal of Cardiac Surgery, 2004
Background: Whether minimally diseased aortic valves should be replaced during other necessary cardiac operations remains controversial. Part of the decision-making process in that issue revolves around the risks of subsequent aortic valve replacement. This study evaluated the results of aortic valve replacement in patients following prior cardiac surgery. Methods: From February, 1984 through December, 2001 first-time aortic valve replacement was performed in 132 consecutive patients who had previous cardiac surgery utilizing cardiopulmonary bypass. Of those patients 89 (67%) had aortic valve replacement at a mean of 8.3 years after prior coronary artery bypass grafting, and 43 (33%) had aortic valve replacement at a mean of 13.0 years after previous procedures other than myocardial revascularization. Hospital records of all patients were retrospectively reviewed. Results: Early complications included operative mortality in six (6.7%) of the patients with prior coronary grafting and no mortality in the group with other prior operations. Patients having prior coronary grafting had more nonfatal complications than those with other previous procedures. Conclusions: Aortic valve replacement in patients following previous cardiac surgery can be accomplished with acceptable mortality and morbidity. Routine replacement of aortic valves that are minimally diseased during coronary artery bypass grafting may not be warranted.