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Aortic valve replacement: a 9-year experience

M L Jacobs, B N Fowler, M P Vezeridis

    The Annals of Thoracic Surgery
    |November 1, 1980
    PubMed
    Summary
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    Cold cardioplegic arrest significantly improves survival after aortic valve replacement compared to coronary perfusion. Early reoperation for prosthetic valve issues is recommended to avoid high mortality risks.

    Area of Science:

    • Cardiovascular Surgery
    • Cardiac Surgery Outcomes
    • Aortic Valve Replacement

    Background:

    • Aortic valve replacement (AVR) is a critical procedure for severe aortic valve disease.
    • Myocardial protection strategies during AVR significantly impact patient outcomes.
    • Paravalvular leaks and prosthetic valve dysfunction are known complications of AVR.

    Purpose of the Study:

    • To review a 9-year experience with aortic valve replacement.
    • To compare the efficacy of direct coronary perfusion versus cold cardioplegic arrest for myocardial protection.
    • To evaluate outcomes related to paravalvular leaks and reoperations.

    Main Methods:

    • Retrospective review of patients undergoing aortic valve replacement over a 9-year period.
    • Comparison of hospital and late mortality between direct coronary perfusion and cold cardioplegic arrest groups.

    Related Experiment Videos

  • Analysis of reoperation rates and outcomes for paravalvular leaks and prosthetic valve dysfunction.

    • Main Results:

    • Overall hospital mortality was 5.0%, with a 15.0% late mortality over a 4.3-year follow-up.
    • Cold cardioplegic arrest had no early deaths, whereas direct coronary perfusion had a 7.5% mortality.
    • Elective reoperations for prosthetic valve dysfunction had no early deaths, but urgent reoperations had a 40% mortality.
    • 80% of patients survived up to 9 years, with 86% of survivors improving functional class.

    Conclusions:

    • Hypothermic cardioplegic arrest is superior to coronary perfusion for myocardial protection during AVR.
    • Early elective reoperation for paravalvular leaks is advisable, especially in patients with prior left ventricular failure, to mitigate high mortality associated with urgent reoperation.