Survival and Long-Term Outcomes of Aortic Valve Replacement in Patients Aged 55 to 65 Years

2017 ◽  
Vol 66 (04) ◽  
pp. 313-321 ◽  
Author(s):  
Shilpa Alex ◽  
Brett Hiebert ◽  
Rakesh Arora ◽  
Alan Menkis ◽  
Pallav Shah
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Cumulative Incidence ◽  
Hazard Ratio ◽  
Middle Aged ◽  
Aged Patients ◽  
Biological Valve ◽  
Mechanical Valves

Background This study aims to compare the outcomes after aortic valve replacement (AVR) with mechanical and biological valves in middle-aged patients (55–65 years) to determine the impact on long-term mortality and morbidity. Methods A retrospective analysis of 373 patients between 55 and 65 years of age who received a primary AVR with or without concomitant coronary artery bypass graft between April 1995 and March 2014. Propensity matching yielded 118 patient pairs in the mechanical and biological valve cohorts. Results Median follow-up time was 6.9 years. No differences in long-term survival or a composite outcome of stroke, bleeding, and endocarditis (major adverse prosthesis-related event; MAPE) were observed in patients receiving biological versus mechanical valves. Actuarial 15-year survival was 46.4% (95% confidence interval [CI], 28.8–62.3%) in the biological valve group versus 60.6% (95% CI, 47.5–71.4%) in the mechanical valve group (hazard ratio, 1.16 [95%CI, 0.69–1.94], p = 0.58). The 15-year cumulative incidence of MAPE was 53.3% (95% CI, 33.7–69.4%) for biological valves versus 24.5% (95% CI, 16.2–33.8%) for mechanical valves (hazard ratio, 0.65 [95% CI, 0.37–1.14], p = 0.12). The 15-year cumulative incidence of reoperation was higher in the bioprosthetic group (26.0% [95% CI, 14.0–39.8%] vs. 5.4% [95% CI, 2.0–11.4%]; hazard ratio 0.24 [95% CI, 0.09–0.68] p < 0.01). Conclusion There is no difference in survival and MAPE at 15 years between biological and mechanical valves. The risk of reoperation was significantly higher in the biological valve group and may affect valve choice in middle-aged patients.

scholarly journals Impact of patient-prosthesis mismatch on 30-day outcomes in young and middle-aged patients undergoing aortic valve replacement

2012 ◽  
Vol 7 (1) ◽  
Author(s):  
Daniel Hernández-Vaquero ◽  
Juan C Llosa ◽  
Rocío Díaz ◽  
Zain Khalpey ◽  
Carlos Morales ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Middle Aged ◽  
Aged Patients ◽  
Patient Prosthesis Mismatch

Aortic valve replacement with mechanical and biologic prostheses in middle-aged patients

2001 ◽  
Vol 71 (5) ◽  
pp. S253-S256 ◽  
Author(s):  
Michel Carrier ◽  
Michel Pellerin ◽  
Louis P Perrault ◽  
Pierre Pagé ◽  
Yves Hébert ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Middle Aged ◽  
Aged Patients

scholarly journals Longest Event-Free Survival without Anticoagulation in a Mechanical Aortic Valve Replacement

2016 ◽  
Vol 10 ◽  
pp. CMC.S31670 ◽  
Author(s):  
Chadi Salmane ◽  
Bhavi Pandya ◽  
Kristen Lafferty ◽  
Nileshkumar J Patel ◽  
Donald McCord
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Platelet Reactivity ◽  
Case Reports ◽  
Term Survival ◽  
Prosthetic Valves ◽  
Mechanical Aortic Valve ◽  
Mechanical Valves

Sixty percent of the patients going for valve replacement opt for mechanical valves and the remaining 40% choose bioprosthetics. Mechanical valves are known to have a higher risk of thrombosis; this risk further varies depending on the type of valve, its position, and certain individual factors. According to current guidelines, long-term anticoagulation is indicated in patients with metallic prosthetic valve disease. We report two unique cases of patients who survived 27 and 37 years event free, respectively, after mechanical aortic valve replacement (AVR) without being on any form of anticoagulation. The latter case described the longest survival in a human with a prosthetic aortic valve without anticoagulation. A review of literature demonstrated few cases of prosthetic valves with no anticoagulation in the long term without significant embolic events reported as case reports. These cases have been summarized in this article. Some cases of long-term survival (in the absence of anticoagulation) were attributed to good luck, and others as the result of genetic variations. New mechanical prosthetic valves can be promising, such as microporus-surfaced valves that may be used without full anticoagulation. The use of dual antiplatelet agents alone can be currently recommended only when a patient cannot take oral anticoagulation after AVR, and it should be followed with measuring and monitoring of platelet reactivity.

Abstract 20004: Long-term Risk of Mortality, Aortic Dissection and Thoracic Aortic Surgery After Isolated Aortic Valve Replacement in Patients With Bicuspid and Tricuspid Aortic Valves

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Shinobu Itagaki ◽  
Yuting Chiang ◽  
Joanna Chikwe
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Cumulative Incidence ◽  
Aortic Surgery ◽  
New York State ◽  
Thoracic Aortic Surgery ◽  
Aortic Valves

Introduction: The natural history of aortopathy after isolated aortic valve replacement (AVR) in patients with bicuspid aortic valves (BAV) is not well characterized. Hypothesis: The incidence of dissection and thoracic aortic surgery after isolated AVR in patients with BAV is higher than in patients with tricuspid valves. Methods: From 1995-2010, 2,203 bicuspid and 1,436 rheumatic tricuspid patients undergoing isolated AVR were identified from the Statewide Planning and Research Cooperative System which captures all inpatient admissions and emergency visits to every hospital in New York State. Deaths were identified from the Social Security Death Master File. Kaplan-Meier analysis of survival and competing risk analysis of aortic dissection and thoracic aortic surgery was performed. Results: BAV patients were younger than tricuspid aortic valve (TAV) patients (52.0 vs. 64.2 years, p<0.001). Survival at 15 years after AVR was 77% versus 58%, respectively (p<0.001). During median follow up of 8.0 years (range 0-19.0 years), aortic dissection occurred in 9 BAV patients versus 4 TAV patients. The 15-year cumulative incidence of dissection after AVR in BAV patients was 0.7% versus 0.4% in TAV patients (p=0.28) (Figure 1). Thoracic aortic surgery was performed in 33 BAV patients versus 9 TAV patients. The 15-year cumulative incidence of thoracic aortic surgery was 3.1% in BAV patients versus 1.1% in TAV patients (p<0.001) (Figure 2). Conclusions: Patients undergoing isolated AVR of bicuspid valves are at greater long-term risk of aortic dissection and thoracic aortic surgery than patients with tricuspid valves, and should be considered for life-long surveillance.

scholarly journals Mechanical valves versus the Ross procedure for aortic valve replacement in children: Propensity-adjusted comparison of long-term outcomes

2009 ◽  
Vol 137 (2) ◽  
pp. 362-370.e9 ◽  
Author(s):  
Bahaaldin Alsoufi ◽  
Zohair Al-Halees ◽  
Cedric Manlhiot ◽  
Brian W. McCrindle ◽  
Mamdouh Al-Ahmadi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Ross Procedure ◽  
Long Term Outcomes ◽  
Mechanical Valves

Incidence, Natural History, and Factors Associated With Paravalvular Leak Following Surgical Aortic Valve Replacement

2019 ◽  
Vol 14 (6) ◽  
pp. 519-530 ◽  
Author(s):  
Vishal N. Shah ◽  
Oleg I. Orlov ◽  
Cinthia P. Orlov ◽  
Meghan Buckley ◽  
Serge Sicouri ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Natural History ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Cumulative Incidence ◽  
Paravalvular Leak ◽  
Surgical Aortic Valve Replacement ◽  
Factors Associated ◽  
Multivariable Analyses

Objective: Our study investigates the incidence, cumulative incidence, natural history, and factors associated with intraoperative paravalvular leak (PVL) and the development of a postoperative PVL in a contemporary consecutive cohort of patients following surgical aortic valve replacement. Methods: A total of 636 patients underwent surgical aortic valve replacement from 2006 to 2016; 410 (64.5%) underwent minimally invasive aortic valve replacement and 226 (35.5%) underwent conventional aortic valve replacement. Primary outcomes were the incidence of intraoperative PVL and cumulative incidence of postoperative PVL. Secondary outcomes were the incidence of in-hospital and long-term death and need for reoperation. Results: The overall incidence of intraoperative PVL was 1.4% (95% confidence interval [CI]: 1% to 3%). All intraoperative PVLs developed in the hand-tied group. The overall incidence of postoperative PVL was 5.3% (95% CI: 4% to 7%). In the univariable and multivariable analyses, postoperative renal failure was the only factor significantly associated with the development of a postoperative PVL. Conclusions: The incidence of intraoperative PVL is low. Cumulative incidence of postoperative PVL was 3.1% (95% CI: 1.0% to 13.6%), 4.3% (95% CI: 1.3% to 16.5%), and 5.0% (95% CI: 1.4% to 17.9%) at 1, 3, and 5 years, respectively. All intraoperative PVLs occurred with hand-tied knots. A larger cohort may identify additional risk factors.

Stentless Bioprostheses for Aortic Valve Replacement in Octogenarians: The Influence of Coronary Artery Disease

2017 ◽  
Vol 66 (04) ◽  
pp. 322-327
Author(s):  
Juergen Ennker ◽  
Behnam Zadeh ◽  
Joern Pons-Kuehnemann ◽  
Bernd Niemann ◽  
Philippe Grieshaber ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Long Term Results ◽  
Aged Patients ◽  
Artery Disease

Background We sought to determine the long-term results of stentless biological heart valve replacement in octogenarians to find out whether coronary artery disease or the coronary artery bypass grafting (CABG) procedure itself influences survival in these aged patients. Methods From 4,012 patients undergoing aortic valve replacement (AVR) with a stentless prosthesis (Freestyle, Medtronic) at a single center, 721 patients were older than 80 years. They had a mean age of 83 ±  2 (2,320 patient years), the male/female ratio was 42:58, NYHA (New York Heart Association) class I and II was prevalent in 22.8%, preoperative atrial fibrillation (AF) in 20.6%, coronary artery disease in 56.1%, mitral valve disease in 12.5%, and aortic disease in 3.5%. Follow-up included a total of 11,546 patient years (mean follow-up time: 74 ± 53 months); follow-up mortality data were 96.3% complete. Results In these aged patients, 30-day mortality in the isolated AVR group (10.3%) was similar to that in the AVR + CABG group (13.4%). Although long-term survival (15 years) in the octogenarian population is low (9% in the AVR group and 6% in the AVR + CABG group), it was not different (p = 0.191) between patients with and without coronary artery disease. The stroke rate and the myocardial infarction rate, respectively, in the AVR + CABG group (0.43%/100 patient years and 0.17%/100 patient years) were only insignificantly higher than that in the isolated AVR group (each 0.01%/100 patient years). The actuarial freedom from reoperation was 99% in both the groups. Conclusion Use of the Freestyle stentless valve prosthesis for AVR is feasible also in octogenarians. The existence of coronary artery disease leads to concomitant bypass surgery, but not a higher level of perioperative or long-term mortality.

scholarly journals Long-term durability of transcatheter aortic valve replacement: outcomes from a contemporary cohort from a tertiary reference center at 5-years and beyond

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Sa Mendes ◽  
P Lopes ◽  
R Campante Teles ◽  
P Araujo Goncalves ◽  
L Raposo ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Cumulative Incidence ◽  
First Generation ◽  
Cumulative Incidence Function ◽  
Incidence Function ◽  
Long Term Follow Up

Abstract Background and aim Long-term data on the durability of transcatheter heart valves is scarce. This is of particular interest as indications expand to younger and lower surgical risk patients. We sought to assess the incidence of long-term structural valve dysfunction (SVD) and bioprosthetic valve failure (BVF) in a cohort of patients with TAVR who reached at least 5-year follow-up, as compared to surgical aortic valve replacement (SAVR), performed within the same time-frame at the same institution. Methods and results Consecutive patients with at least 5-year available follow-up, who underwent TAVR between November 2008 to December 2015 in a tertiary single center, were included. From a group of 246 patients undergoing TAVR, 126 had available follow-up data (age at implantation: 83.0 [77.8–87.0] years; EuroScore II: 4.54 [2.60–6.29]%; follow-up: 5.94 [5.06–7.67] years). First generation Corevalve® and Sapien® prosthesis were implanted in 56% and 38% patients, respectively. SVD and BVF were defined according to the new consensus statement from the EAPCI endorsed by the ESC and the EACTS. Mean transaortic pressure gradients decreased from 53.2±1.3 mmHg (pre-TAVR) to 10.4±0.4 mmHg (at discharge or up to one-year after TAVR, p&lt;0.001), and there was a small non-significant increase at the fifth-year and the last available follow-up (11.2±0.6 mmHg; 14.7±1.8 mmHg, respectively). Moderate and severe SVD were reported in 12 and 4 patients, respectively (8-year cumulative incidence function to SVD: 2.67%; 95% CI, 2.12–3.89). Of these 8 had BVF, 7 of them with hospitalization for acute heart failure. A total of 4 patients died and none required reintervention (redo TAVR or SAVR). BVF for non-SVD were observed in 4 patients (2 subclinic thrombosis successfully treated with anticoagulation and 2 paravalvular regurgitation due to endocarditis). As comparator, from a cohort of 587 patients submitted to biological SAVR, 247 (age 75.0 [70.0–79.0] years; EuroScore II 1.43 [1.06–2.17]%) had available long-term follow-up (6.89 [6.08–8.19] years). Moderate and severe SVD were reported in 42 and 3 patients, respectively (8-year cumulative incidence function to SVD: 3.13%; 95% CI, 2.45–4.21). These events were clinically relevant (BVF) in 19 of them: 8 performed TAVR valve-in-valve procedures and 3 redo SAVR. At the fifth-year of follow-up the incidence of SVD was not statistically different between TAVR (8%) and SAVR (15%), with a p for comparison of 0.137. Conclusions In our population of patients with symptomatic severe aortic stenosis treated with first-generation percutaneous bioprostheses, TAVR was associated with a low incidence of BVF and SVD at the long-term follow-up. These outcomes seem indistinct from those occurring in patients submitted to conventional SAVR FUNDunding Acknowledgement Type of funding sources: None. KM curve reporting probability of SVD

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