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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
- 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.
- Subjects :
- Aortic valve
Adult
Male
medicine.medical_specialty
lcsh:Diseases of the circulatory (Cardiovascular) system
Time Factors
Adolescent
medicine.medical_treatment
lcsh:Surgery
030204 cardiovascular system & hematology
03 medical and health sciences
Young Adult
0302 clinical medicine
Postoperative Complications
Aortic valve replacement
Internal medicine
medicine
Humans
Mortality
Child
Survival rate
Aged
Retrospective Studies
Aged, 80 and over
Heart Valve Prosthesis Implantation
Bioprosthesis
Univariate analysis
Ejection fraction
business.industry
Mitral valve replacement
General Medicine
Aortic Valve Stenosis
lcsh:RD1-811
Middle Aged
medicine.disease
Surgery
Survival Rate
Stenosis
medicine.anatomical_structure
Treatment Outcome
030228 respiratory system
lcsh:RC666-701
Aortic valve stenosis
Cardiology
Original Article
Female
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- Language :
- English
- ISSN :
- 16789741
- Volume :
- 31
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Brazilian Journal of Cardiovascular Surgery
- Accession number :
- edsair.doi.dedup.....42feb5e6808aacad6ae01cab24ae7bec