Related Experiment Videos
Aortic valve replacement: a 9-year experience
Insights
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.
- 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.
Abstract:
Experience with aortic valve replacement over a 9-year period is reviewed. Hospital mortality was 5.0%, 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 III or IV before operation are now in Class I or II. 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.