Long-term results of mitral-aortic valve operations.
J Thorac Cardiovasc Surg
; 115(6): 1298-309, 1998 Jun.
Article
em En
| MEDLINE
| ID: mdl-9628671
ABSTRACT
OBJECTIVE:
We analyzed the long-term morbidity and mortality of our experience with combined mitral-aortic surgery, as well as their determinants.METHODS:
Among 2109 consecutive patients undergoing valve operations, 200 had mitral-aortic valve procedures with at least implantation of a mechanical prosthesis 163 of 200 (81.5%) patients had double valve replacement and 37 of 200 (18.5%) had mitral valve repair and aortic valve replacement. All mechanical valves were bileaflet prostheses. Preoperatively, 171 of 200 (85.5%) patients were in New York Heart Association class III-IV. Event-free survivals were determined by means of the Kaplan-Meier method and determinants of survivals with the Cox proportional hazards model (p < 0.05) entering 39 preoperative and perioperative factors. Follow-up was complete for 96% of the patients (192/200).RESULTS:
Overall survivals at 5, 10, and 15 years were 88.5% +/- 0.55%, 73.5% +/- 4%, and 53.3% +/- 8.9%, and rates of freedom from valve-related mortality were 92.9% +/- 1.5%, 85.8% +/- 3.5%, and 85.8% +/- 3.5%. The rates of freedom from permanent valve-related impairment were 91.5% +/- 1.7%, 85.4% +/- 3.5%, and 79.3% +/- 6.7%, and those from all valve-related mortality and morbidity were 74.1% +/- 2.3%, 53.8% +/- 5%, and 49% +/- 5.6%. At last follow-up, 90% (139/154) of the survivors were in New York Heart Association class I-II. Left ventricular ejection fraction less than 50%, age older than 70 years, and preoperative ventricular arrhythmias were independent risk factors for valve-related late deaths. Diabetes, ejection fraction less than 50%, and coronary artery disease were independent determinants of all valve-related events.CONCLUSIONS:
Functional results of survivors of combined mitral-aortic surgery are excellent. However long-term valve-related morbidity and mortality are substantial. In the patient population studied, the predictors are determined by patient-related factors, mainly myocardial factors, but not by valve-related factors.
Buscar no Google
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Valva Aórtica
/
Próteses Valvulares Cardíacas
/
Implante de Prótese de Valva Cardíaca
/
Doenças das Valvas Cardíacas
/
Valva Mitral
Tipo de estudo:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
J Thorac Cardiovasc Surg
Ano de publicação:
1998
Tipo de documento:
Article
País de afiliação:
Suíça