Factors Determining In-Hospital or Late Survival after Aortic Valve Replacement: Outcome
Myocardial protection, even with the use of crystalloid cardioplegia, was not complete, as the most common cause of in-hospital mortality was either low’ cardiac output or myocardial infarction. This is particularly true in the initial experiences, when the recently introduced hyperka-lemic crystalloid cardioplegia was used as a single dose, even in those procedures necessitating prolonged aortic cross-clamp time. Incremental risk factors for in-hospital mortality were age over 60 years, advanced preoperative NYHA functional classification, and early year of operation. Early year of operation represents a learning curve in effective cardioplegic myocardial protection. www.mycanadianpharmacy.com
Myocardial infarction and infective endocarditis were the two most common causes of late deaths. Incremental risk factors identified by univariate and multivariate logistic regression analysis were advanced age, advanced preoperative functional classification, and early year of operation. Hazard function for late mortality, although constant, was very low up to 60 months and then had an exponential increase 75 and 80 months after valve implantation.
This instantaneous risk was more pronounced in patients who had undergone concomitant procedures in addition to the AVR Actuarial survival of patients was also markedly divided between those undergoing isolated AVR (69 percent at 8.7 years) and those undergoing concomitant procedures, mainly coronary artery bypasses and multivalve replacement (49 percent). The difference is significant (p = 0.001). It is of interest that patients undergoing valve replacement and coronary artery bypass had a similar actuarial survival as those undergoing isolated valve replacement. This suggests that patients receiving good myocardial revascularization concomitant to AVR revert to a actuarial survival similar to patients without coronary artery disease.