Ismail Bouhout1, Louis-Mathieu Stevens2, Amine Mazine1, Nancy Poirier1, Raymond Cartier1, Philippe Demers1, Ismail El-Hamamsy3. 1. Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada. 2. Department of Cardiac Surgery, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Canada. 3. Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada. Electronic address: i.elhamamsy@icm-mhi.org.
Abstract
OBJECTIVES: The aim of this study was to determine long-term survival and clinical outcomes after elective isolated mechanical aortic valve replacement in young adults. METHODS: A clinical observational study was conducted in a cohort of 450 consecutive adults less than 65 years of age who had undergone elective isolated mechanical aortic valve replacement (AVR) between 1997 and 2006. Patients who had undergone previous cardiac surgery, and those undergoing concomitant procedures or urgent surgery were excluded. Follow-up was 93.3% complete with a mean follow-up of 9.1±3.5 years. The primary end point was survival. Life table analyses were used to determine age- and gender-matched general population survival. Secondary end points were reoperation and valve-related complications. RESULTS: Overall actuarial survival at 1, 5, and 10 years was 98%±1%, 95%±1%, and 87%±1%, respectively, which was lower than expected in the age- and gender-matched general population in Quebec. Actuarial freedom from prosthetic valve dysfunction was 99%±0.4%, 95%±1%, and 91%±1% at 1, 5, and 10 years, respectively. Actuarial freedom from valve reintervention was 98%±1%, 96%±1%, and 94%±1% at 1, 5 and 10 years, respectively. Actuarial survival free from reoperation at 10 years was 82%±2%. Actuarial freedom from major hemorrhage was 98%±1%, 96%±1%, and 90%±2% at 1, 5, and 10 years, respectively. CONCLUSIONS: In young adults undergoing elective isolated mechanical AVR, survival remains suboptimal compared with an age- and gender-matched general population. Furthermore, there is a low but constant hazard of prosthetic valve reintervention after mechanical AVR.
OBJECTIVES: The aim of this study was to determine long-term survival and clinical outcomes after elective isolated mechanical aortic valve replacement in young adults. METHODS: A clinical observational study was conducted in a cohort of 450 consecutive adults less than 65 years of age who had undergone elective isolated mechanical aortic valve replacement (AVR) between 1997 and 2006. Patients who had undergone previous cardiac surgery, and those undergoing concomitant procedures or urgent surgery were excluded. Follow-up was 93.3% complete with a mean follow-up of 9.1±3.5 years. The primary end point was survival. Life table analyses were used to determine age- and gender-matched general population survival. Secondary end points were reoperation and valve-related complications. RESULTS: Overall actuarial survival at 1, 5, and 10 years was 98%±1%, 95%±1%, and 87%±1%, respectively, which was lower than expected in the age- and gender-matched general population in Quebec. Actuarial freedom from prosthetic valve dysfunction was 99%±0.4%, 95%±1%, and 91%±1% at 1, 5, and 10 years, respectively. Actuarial freedom from valve reintervention was 98%±1%, 96%±1%, and 94%±1% at 1, 5 and 10 years, respectively. Actuarial survival free from reoperation at 10 years was 82%±2%. Actuarial freedom from major hemorrhage was 98%±1%, 96%±1%, and 90%±2% at 1, 5, and 10 years, respectively. CONCLUSIONS: In young adults undergoing elective isolated mechanical AVR, survival remains suboptimal compared with an age- and gender-matched general population. Furthermore, there is a low but constant hazard of prosthetic valve reintervention after mechanical AVR.
Authors: Amine Mazine; Rodolfo V Rocha; Ismail El-Hamamsy; Maral Ouzounian; Bobby Yanagawa; Deepak L Bhatt; Subodh Verma; Jan O Friedrich Journal: JAMA Cardiol Date: 2018-10-01 Impact factor: 14.676
Authors: Maria von Stumm; Tatjana Sequeira-Gross; Johannes Petersen; Shiho Naito; Lisa Müller; Christoph Sinning; Evaldas Girdauskas Journal: Cardiovasc Diagn Ther Date: 2021-04