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Long-term Mortality Predictors in Patients with Small Aortic Annulus Undergoing Aortic Valve Replacement with a 19- or 21-mm Bioprosthesis

Authors :
Antoninho S Arnoni
Jenny Lourdes Rivas de Oliveira
Antonio Flávio Sanchez de Almeida
Paulo Chaccur
Magaly Arrais dos Santos
Luiz Carlos Bento de Souza
Renato Tambellini Arnoni
Mário Issa
Source :
Brazilian Journal of Cardiovascular Surgery, Vol 31, Iss 4, Pp 275-280, Brazilian Journal of Cardiovascular Surgery, Volume: 31, Issue: 4, Pages: 275-280, Published: SEP 2016, Brazilian Journal of Cardiovascular Surgery v.31 n.4 2016, Brazilian Journal of Cardiovascular Surgery, Sociedade Brasileira de Cirurgia Cardiovascular (SBCCV), instacron:SBCCV
Publisher :
Sociedade Brasileira de Cirurgia Cardiovascular

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.

Details

Language :
English
ISSN :
16789741
Volume :
31
Issue :
4
Database :
OpenAIRE
Journal :
Brazilian Journal of Cardiovascular Surgery
Accession number :
edsair.doi.dedup.....42feb5e6808aacad6ae01cab24ae7bec