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Valvular replacement for aortic stenosis on patients in NYHA class III and IV. Early and long term results
J F Obadia1, A Eker, G Rescigno
1Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, France.
Insights
Aortic valve replacement surgery significantly improves survival and functional status for patients with aortic stenosis, even in advanced stages. Early intervention is recommended, as outcomes appear superior to medical management alone.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Outcomes
Background:
- Aortic stenosis is a significant cardiovascular condition requiring timely intervention.
- Clinical assessment of disease severity is crucial for prognosis.
- Surgical intervention for aortic stenosis has evolved over decades.
Purpose of the Study:
- To evaluate the long-term outcomes of surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis.
- To assess the impact of SAVR on survival and functional status.
- To compare surgical outcomes with medical management.
Main Methods:
- Retrospective analysis of 112 patients (NYHA class III/IV) who underwent aortic valve surgery between 1972 and 1990.
- Data collection included patient demographics, clinical status, early mortality, and actuarial survival.
- Actuarial survival rates were calculated at 1, 5, 10, and 15 years post-surgery.
Main Results:
- Early mortality was 7.14% (8 patients).
- Actuarial survival rates were 88.39% (1 year), 77.67% (5 years), 67.85% (10 years), and 65.7% (15 years).
- Aortic valve replacement improved survival and functional status, even in advanced cases.
Conclusions:
- Clinical criteria remain the most reliable prognostic indicators for aortic stenosis.
- Surgical aortic valve replacement is indicated upon symptom onset and offers improved outcomes compared to medical therapy alone.
- Despite increased operative risks and potential for secondary cardiomyopathy, SAVR provides significant benefits in survival and function.
Abstract:
From January 1972 to June 1990, 112 patients between 39 and 83 years old, divided into 68 NYHA class III (60.72%) and 44 NYHA class IV, underwent surgery for aortic stenosis. There were 67 male (59.82%) and 45 female (40.18%). Early mortality included 8 patients (7.14%). Actuarial survival (including early postoperative mortality) for all 112 patients was 88.39%, 77.67%, 67.85% and 65.7% t one year, five, ten and fifteen years respectively. Clinical criteria are subjective but they remain the best prognostic factor. Surgery is indicated at occurrence of first symptoms, but, even in advanced cases, aortic valvular replacement can significantly improve survival and functional status. Even if operative risk is increased and secondary cardiomyopathy often progresses after surgery, aortic valve replacement results seem better than those of medical treatment alone.