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13. Factors Determining In-Hospital or Late Survival after Aortic Valve Replacement

Author

Gonzalez-Lavin, Lorenzo, Gonzalez-Lavin, Julie, McGrath, Lynn B., Amini, Saeid, and Graf, Debra

Abstract

To ascertain incremental risk factors for in-hospital and late mortality of patients undergoing AVR with the bovine pericardial valve, multiple variables were analyzed in a group of 240 patients undergoing AVR between 1977 and 1983. Follow-up totaled 12,023 patient-months (mean, 52.7 ± 1.7 patient-months) and was 100 percent complete. Univariate analysis of incremental risk factors for in-hospital mortality identified the following: age over 60 years (p = 0.015); and advanced preoperative NYHA class (p = 0.003). Multivariate analysis of risk factors for in-hospital mortality identified the following: age (p = 0.038); NYHA class (p = 0.018); and year of operation (p = 0.049). Incremental risk factors for late mortality were identified as age (p = 0.003), year of operation (p = 0.003), concomitant procedure (p = 0.047), and valvular lesion (regurgitation) (p = 0.053). Actuarial survival of patients (±SE) was 87 ± 2 percent, 75 ± 3 percent, and 61 ± 5 percent at 2, 5, and 8.7 years, respectively. The actuarial survival of patients experiencing valve-related events was 62.6 ± 10.1 percent at 8.7 years, compared to 55.4 ± 7 percent for those who did not (p = 0.38). (Chest 1989; 95:38-42)

Published
1989
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14. Instantaneous Risk of Events Following Aortic Valve Replacement with Pericardial Valves: A Ten-Year Experience

Author

Gonzalez-Lavin, Lorenzo, Amini, Saeid, Gonzalez-Lavin, Julie, McGrath, Lynn B., Fernandez, Javier, and Graf, Debra

Subjects
17th Annual Symposium
Abstract

Actuarial curves and linearized rates of occurrence are statistical functions that traditionally have been used to evaluate freedom from, or incidence of, valve-related events that occur as a result of aortic valve replacement (AVR); however, the instantaneous risk of an event can be more precisely pinpointed by the use of a time-related hazard function. This function was used to analyze 240 cases involving patients who underwent AVR with the Ionescu-Shiley bovine pericardial valve. Follow-up was for 10 years. The period from 60 to 70 months after implantation was apparently critical, since specific and cumulative events (intrinsic tissue failure, thromboembolism, prosthetic valve endocarditis, cumulated events, and death due to valve-related events) peaked during this period. We suspect important degenerative bioprosthetic changes take place during this period and are the cause, in part, for this pattern. In an effort to reduce the incidence of thromboembolism, close observation, and probably antiplatelet drug administration, should be initiated 60 months after implantation of this valve. (Texas Heart Institute Journal 1988;15:31-34)

Published
1988

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