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Immediate and late results of aortic valve replacement with the Björk-Shiley tilting disc valve
Insights
Aortic valve replacement surgery significantly improved patient outcomes, with most survivors achieving better functional capacity. While early and late mortality rates were observed, myocardial failure was the primary cause of death.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Outcomes
Background:
- Aortic valve disease necessitates surgical intervention to improve patient survival and quality of life.
- Assessing the long-term efficacy and safety of aortic valve replacement is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the outcomes of single aortic valve replacement surgery.
- To assess changes in functional class, heart volume, and electrocardiographic parameters post-surgery.
- To identify risk factors associated with mortality after aortic valve replacement.
Main Methods:
- A retrospective analysis of 110 patients who underwent single aortic valve replacement between 1971 and 1976.
- Follow-up ranged from 1 to 6 years, with data collection on mortality, functional status (N.Y.H.A. class), heart volume, and electrocardiographic measurements.
- Statistical analysis to determine significant changes and identify risk factors.
Main Results:
- Early postoperative mortality was 6.3%, and late mortality was 8.2%.
- Postoperative functional class improved significantly, with 99% of survivors in Class I or II (compared to 71% in Class III/IV pre-operatively).
- Significant reductions were observed in mean heart volume (610 to 512 ml/m2) and left ventricular hypertrophy (56mV to 42mV), both with p < 0.001.
Conclusions:
- Single aortic valve replacement leads to substantial functional improvement and objective evidence of cardiac remodeling.
- Myocardial failure was the predominant cause of death, with sudden death noted in the late mortality group.
- Advanced age was not a risk factor, but alcoholism was associated with increased mortality.
Abstract:
Single aortic valve replacement was performed in 110 patients at Ullevål Hospital, Oslo, between 1971 and 1976. The follow-up period was 1 to 6 years (mean 31 months). The early postoperative mortality was 6.3% and the late mortality 8.2%. Postoperatively 44% of the surviving patients were in the N.Y.H.A. functional class I and 55% in class II, while 71% of the patients were in class III or IV pre-operatively. Objective evidence of improvement was shown by reduction in mean heart volume from 610 ml/m2 pre-operatively to 512 ml/m2 postoperatively (p less than 0.001). Electrocardiographic signs of left ventricular hypertrophy, measured as the combined voltage of Smax and Rmax in V1 to V6, were 56mV pre-operatively and 42 mV postoperatively (p less than 0.001). Myocardial failure was the main cause of death postoperatively. Sudden death occurred in 5 of the 9 patients in the late mortality group. Old age at the time of operation (65 to 71 years) was not associated with increased risk of death and complications, while alcoholism did increase the mortality rate.