Related Experiment Video
Updated: Aug 18, 2026
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Determinants of long-term survival after isolated aortic valve replacement: a 10- to 17-year follow-up
1Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
Insights
Early aortic valve replacement (AVR) for aortic stenosis (AS) or aortic regurgitation (AR) improves long-term survival. Prompt intervention before severe symptoms arise is crucial for better patient outcomes in cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Disease
- Medical Technology and Outcomes
Background:
- Aortic stenosis (AS) and aortic regurgitation (AR) are significant valvular heart conditions requiring intervention.
- Surgical aortic valve replacement (AVR) is a primary treatment, but optimal timing remains a key consideration.
- Historical data on long-term outcomes following AVR are essential for refining clinical practice guidelines.
Purpose of the Study:
- To evaluate the long-term survival rates and identify prognostic factors following isolated aortic valve replacement (AVR).
- To compare outcomes between earlier and later periods of AVR performance.
- To determine if early intervention in aortic stenosis (AS) and aortic regurgitation (AR) impacts survival.
Main Methods:
- Retrospective analysis of 165 patients who underwent isolated AVR between January 1965 and December 1973.
- Operations performed using total cardiac arrest with chemical cardioplegia and predominantly Starr-Edwards caged ball valves.
- Survival rates analyzed using cumulative survival curves and compared to a sex- and age-matched control population.
Main Results:
- The 5-, 10-, and 15-year survival rates were 78%, 62%, and 29%, respectively, with excess mortality in the first postoperative year and after 12 years.
- Patients undergoing AVR in 1972-1973 showed improved 5- and 10-year survival (81% and 72%) compared to those operated on from 1965-1971.
- Higher 1-year survival rates were observed for AS (91%) versus AR (71%) patients. Adverse prognostic factors identified for both AS and AR.
Conclusions:
- Aortic valve replacement (AVR) offers long-term survival benefits, with outcomes improving over time.
- Early surgical intervention for AS and AR, before the onset of severe symptoms and signs, is associated with better long-term prognosis.
- Identification of specific adverse prognostic factors in AS and AR patients underscores the importance of timely surgical consideration.
Abstract:
During a 9-year period from January 1965 through December 1973, we performed isolated aortic valve replacement (AVR) for aortic stenosis (AS) or aortic regurgitation (AR) in 165 patients. All operations were done during total cardiac arrest using chemical cardioplegia according to the method of Bretschneider. The prostheses used were predominantly Starr-Edwards caged ball valves. One hundred thirty-nine patients were alive 30 days after operation. The 5-, 10-, and 15-year cumulative survival rates (+/- SE) were 78 +/- 4%, 62 +/- 4%, and 29 +/- 9%, respectively. In comparison to a sex- and age-matched control population, our patients had an excess mortality in the first postoperative year and again after the twelfth year. Patients who underwent AVR in 1972 and 1973 had better results than those who had operations in 1965 through 1971 (p < 0.05); the 1972-1973 patients had 5- and 10-year survival rates of 81 +/- 5% and 72 +/- 5%, respectively. The 1-year survival rate was 91% for patients with AS and 71% for those with AR (p < 0.05). In AS patients, long-term survival was adversely affected by a history of left ventricular failure, inclusion in NYHA functional class IV, cardiothoracic index of >/= 0.56, cardiac index of < 3.0 L/min/m(2), age > 55 years, previous myocardial infarction, systemic pulse pressure of /= 15 mm Hg, and mean pulmonary artery pressure of >/= 24 mm Hg. In AR patients, an adverse prognosis was associated with left ventricular failure, syncope, age >/= 60 years, and NYHA class IV status. These results indicate that, in both AS and AR patients, operation should be performed early, before severely limiting symptoms and signs arise.
More Related Videos
Related Concept Videos
01:15Aortic Regurgitation I: Introduction
01:25Aortic Regurgitation III: Medical Management