An analysis of risk factors for death and mode-specific death after aortic valve replacement with allograft, xenograft, and mechanical valves

D. C. McGiffin, M. F. O'Brien, A. J. Galbraith, G. J. McLachlan, E. G. Stafford, M. A.H. Gardner, P. G. Pohlner, L. Early, L. Kear

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Abstract

From September 1967 to January 1990, a total of 2100 patients underwent 2366 aortic valve replacements with a variety of allograft, xenograft, and mechanical valves. Concomitant procedures were performed in 764 patients. Actuarial survival at 12 years was 59.6 % (70% confidence limits 57.8% to 61.4%). Hazard function for death was highest immediately after operation, falling to merge with a slowly rising phase of risk at approximately 3 months. Actuarial freedom from sudden death at 12 years was 88.0% (70% confidence limits 86.7% to 89.3%). The shape of the hazard function for sudden death was similar to that for death. Actuarial freedom from death with cardiac failure at 12 years was 87.9% (70% confidence limits 86.5% to 89.2%). The shape of the hazard function for death with cardiac failure was also similar to that for death. Risk factor analysis revealed the important deleterious impact on long-term survival resulting from impaired left ventricular structure and function because of aortic valve disease. No current-era valve used in this study (allograft, xenograft, or mechanical) was a risk factor for death. Both aortic wall disease and endocarditis necessitating aortic valve replacement substantially decreased long-term patient survival. Aortic valve replacement is advisable much earlier in the natural history of aortic valve disease before secondary left ventricular damage occurs.

Original languageEnglish
Pages (from-to)895-911
Number of pages17
JournalJournal of Thoracic and Cardiovascular Surgery
Volume106
Issue number5
DOIs
Publication statusPublished - 1 Jan 1993
Externally publishedYes

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