Factors Determining In-Hospital or Late Survival after Aortic Valve Replacement: Conclusion
The p value became significant at 8.7 years, in contrast to a previous analysis in which actuarial survival was the same at six years. In addition, there was a significant difference in survival between patients with advanced age or advanced functional class when compared with people younger than 62 years of age or in class 1 and class 2. my canadian pharmacy online
Although the instantaneous risk of death due to valve-related events is constant and low, this series emphasizes that these patients enjoy a good quality of life up to 70 months following implantation. Thereafter, an increased instantaneous risk of valve-related events and late death is present, suggesting important degenerative changes in the leaflets have taken place, with a concurrent increase in valve-related events that may influence late mortality. Of the valve-related events influencing mortality, the most prevalent was infective endocarditis, which occurred at perhaps a slightly higher level than in most other reported series. The mortality index of this event was significant (50 percent). The mortality index of intrinsic valve failure was 5.8 percent. In our experience the pericardial valve performed well up to 75 months, with a low incidence of valve-related events. Infective endocarditis had a higher mortality index which affected both in-hospital and late survival of patients. Intrinsic tissue failure did not affect overall actuarial survival when the patients underwent the first reoperation.
This study typifies the problems to be faced in the future with an increasingly elderly population undergoing AVR. Advanced age and preoperative decompensation were two major factors determined to adversely affect in-hospital and late survival after AVR. This study reveals the importance of referral of patients before cardiac decompensation occurs, as well as operating on younger patients if the diagnosis of severe valvular disease is present. It also suggests more current methods of myocardial protection should improve cardiac function and survival of patients, due to a decreased incidence of perioperative myocardial infarction.