Outcome and risk factors after aortic valve interventions

Abstract: In the present study the long-term survival and morbidity and the associated risk factors after aortic valve replacement (AVR) and after aortic balloon valvuloplasty were evaluated. In a cohort of 2,359 consecutive patients undergoing primary aortic valve replacement, the early mortality was 5.6%. The late observed 10-year survival was 63%, whereas the late relative survival, i.e. the survival in the study population compared to a background population, was 84%. Independent risk factors associated with late relative survival were advanced NYHA class (relative hazard [RH] 2.0), atrial fibrillation (RH 1.8) and pure aortic regurgitation (RH 1.5). High age was a risk factor for observed mortality, but not for excess mortality.A series of 424 patients were enrolled in a prospective study after AVR with a mechanical prosthesis. During a median follow-up of 10 years, 583 morbid events were recorded in 57% of the patients. The incidence of cerebral thromboembolism expressed as linearised rate was 4.4% per patient-year, and the corresponding figure for haemorrhage was 8.5%. One-fifth of the study population experienced repeated episodes of thromboembolism and/or haemorrhage. Both haemorrhage and thromboembolism prior to surgery were strong risk factors for such respective events after AVR, and when these events occurred after surgery the risk for subsequent events was even stronger.Balloon aortic valvuloplasty (BAV) was attempted in a series of 64 elderly patients with aortic stenosis causing severe disability. This intervention resulted in a short-term improvement of symptoms. The 3-year survival afher BAV was 37%, which was unfavourable in comparison with the corresponding result, 77%, in a control group of patients after AVR. Thus, BAV should not be regarded as an alternative to AVR.In the present study, different categories of patients who had undergone AVR were found to have an increased risk for death and morbid events. The future management of such patients needs to be improved in order to optimise the long-term outcome for the total population undergoing AVR.

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