Long-term mortality predictors in patients with small aortic annulus undergoing aortic valve replacement with a 19- or 21-mm bioprosthesis
Rev. bras. cir. cardiovasc
;
31(4): 275-280, July-Sept. 2016. tab, graf
Article
in English
| LILACS, SES-SP, SESSP-IDPCPROD, SES-SP
| ID: biblio-829736
ABSTRACT
Abstract Introduction:
Replacement of the aortic valve in patients with a small aortic annulus is associated with increased morbidity and mortality. A prosthesis-patient mismatch is one of the main problems associated with failed valves in this patient population.Objective:
To evaluate the long-term mortality predictors in patients with a small aortic annulus undergoing aortic valve replacement with a bioprosthesis.Methods:
In this retrospective observational study, a total of 101 patients undergoing aortic valve replacement from January 2000 to December 2010 were studied. There were 81 (80.19%) women with a mean age of 52.81±18.4 years. Severe aortic stenosis was the main indication for surgery in 54 (53.4%) patients. Posterior annulus enlargement was performed in 16 (15.8%) patients. Overall, 54 (53.41%) patients underwent concomitant surgery 28 (27.5%) underwent mitral valve replacement, and 13 (12.7%) underwent coronary artery bypass graft surgery.Results:
Mean valve index was 0.82±0.08 cm2/m2. Overall, 17 (16.83%) patients had a valve index lower than 0.75 cm2/m2, without statistical significance for mortality (P=0.12). The overall 10-year survival rate was 83.17%. The rate for patients who underwent isolated aortic valve replacement was 91.3% and 73.1% (P=0.02) for patients who underwent concomitant surgery. In the univariate analysis, the main predictors of mortality were preoperative ejection fraction (P=0.02; HR 0.01) and EuroSCORE II results (P=0.00000042; HR 1.13). In the multivariate analysis, the main predictors of mortality were age (P=0.01, HR 1.04) and concomitant surgery (P=0.01, HR 5.04). Those relationships were statistically significant.Conclusion:
A valve index of < 0.75 cm2/m2 did not affect 10-year survival. However, concomitant surgery and age significantly affected mortality.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Aortic Valve Stenosis
/
Bioprosthesis
/
Heart Valve Prosthesis Implantation
Type of study:
Observational study
/
Prognostic study
/
Risk factors
Limits:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Child
/
Female
/
Humans
/
Male
Language:
English
Journal:
Rev. bras. cir. cardiovasc
Year:
2016
Type:
Article
Institution/Affiliation country:
Instituto Dante Pazzanese de Cardiologia/BR
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