Survival and valve failure after aortic valve replacement.

Area of Science:

• Cardiovascular Surgery
• Biomaterials Science
• Clinical Outcomes Research

Background:

• Aortic valve replacement is a critical procedure for managing severe aortic valve disease.
• The choice of prosthetic valve can influence long-term patient outcomes.
• Understanding determinants of survival and valve failure is essential for optimizing patient care.

Purpose of the Study:

• To prospectively evaluate survival and valve failure determinants after isolated aortic valve replacement.
• To compare outcomes among different types of prosthetic valves implanted.
• To identify factors influencing valve-related complications and thromboembolism.

Main Methods:

• Prospective evaluation of 412 patients undergoing isolated aortic valve replacement.
• Implantation of Björk-Shiley mechanical, Ionescu-Shiley pericardial, Hancock pericardial, and Carpentier-Edwards porcine valves.
• Actuarial survival analysis and Cox regression for determinant identification.

Main Results:

• Overall actuarial survival was 81% +/- 3% at 48 months.
• Advancing age, higher preoperative New York Heart Association class, and endocarditis were independent predictors of mortality.
• Freedom from structural valve dysfunction, endocarditis, and reoperation were 95%, 95%, and 92% at 48 months, respectively.
• Hancock pericardial valves showed higher rates of structural dysfunction, endocarditis, and reoperation, particularly in younger patients.
• Freedom from thromboembolism was 88% +/- 2% at 48 months, unaffected by prosthesis type.

Conclusions:

• Patient age, preoperative functional status, and endocarditis significantly impact survival after aortic valve replacement.
• While overall valve durability is high, specific valve types (Hancock pericardial) and patient demographics influence complication rates.
• Symptomatic improvement is substantial post-procedure, highlighting the benefits of aortic valve replacement.