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Factors Determining In-Hospital or Late Survival after Aortic Valve Replacement: Results

Factors Determining In-Hospital or Late Survival after Aortic Valve Replacement: ResultsCauses of in-hospital mortality have been tabulated (Table 1). Univariate logistic regression analysis identified age over 60 years (p = 0.015) and advanced preoperative NYHA functional class (3 and 4) (p = 0.003) as incremental risk factors affecting inhospital survival. Incremental risk factors by multivariate analysis were age over 60 years (p = 0.038), advanced preoperative NYHA functional class (p = 0.018), and earlier year of operation (p = 0.049).
Late Mortality
The 224 patients dismissed from the hospital have been followed 1,003.2 patient-years (mean, 53.7 ± 1.6 years). Fifty-one deaths (23 percent) occurred during this follow-up time (70 percent CL = 19.8, 26.0). The patients age at time of death ranged from 23 to 86 years (mean, 71 years of age). The causes of death are tabulated (Table 2). Thirty-two (14 percent or 32/224) of these were cardiac-related (70 percent CL =11.8, 17.1), of which seven (3 percent or 7/224) were valve-related (70 percent CL = 1.9, 4.8). Of the valve-related deaths, six (3 percent or 6/224) were due to infective prosthetic endocarditis (70 percent CL= 1.6, 4.3), and one (0.5 percent or 1/224) was directly related to intrinsic tissue failure of the valvular prosthesis (70 percent CL = 0.006, 1.5). Univariate logistic regression analysis identified age over 60 years (p = 0.0009), earlier year of operation (p = 0.004), and concomitant procedure (p = 0.007) as incremental risk factors affecting long-term survival. Incremental risk factors by multivariate analysis were identical with p values of 0.003, 0.003, and 0.047, respectively. itat on

The application of time-related hazard function revealed that the instantaneous risk of late mortality was low but constant and then peaked at about six years (Fig 1). The instantaneous risk of late death peaked simultaneously for patients after isolated AVR or those with concomitant procedures, but was significantly lower in patients with isolated AVR (p^0.00001) (Fig 2).
Table 1—Causes of In-Hospital Mortality

Cause No. (percent) (N = 16) No. (percent) (N = 240)
Low cardiac output 5 (31) 5 (2)
Myocardial infarction 4 (25) 4 (2)
Arrhythmias 2 (13) 2 (1)
Renal failure 2 (13) 2 (1)
Pulmonary failure 1 (6) 1 (0.4)
Ruptured RV* 1 (6) 1 (0.4)
Septic shock 1 (6) 1 (0.4)

Table 2—Causes of Late Mortality

Cause No. (percent) (N = 51) No. (percent) (N = 224)
Noncardiac-related 19 (37) 19 (8)
Cardiac-related 32 (63) 32 (14)
Myocardial infarction* 10 (20) 10 (4)
Infective endocarditis 9 (18) 9 (4)
Chronic heart failure 7 (14) 7 (3)
Arrhythmias 5 (10) 5 (2)
Thrombosis of MV prosthesist 1 (2) 1 (0.4)

 

Figure 1. The instantaneous risk of late mortality as assessed by hazard function was low but constant until six years, at which time it peaked.Figure 1. The instantaneous risk of late mortality as assessed by hazard function was low but constant until six years, at which time it peaked.

Figure 2. The instantaneous risk of late mortality as assessed by hazard function peaked simultaneously for patients with and without concomitant procedures. However, the peak was significantly lower in patients with isolated AVR.Figure 2. The instantaneous risk of late mortality as assessed by hazard function peaked simultaneously for patients with and without concomitant procedures. However, the peak was significantly lower in patients with isolated AVR.

Category: Aortic Valve Replacement

Tags: aortic cross-clamp time, aortic valve replacement, cardioplegia, myocardial infarction

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