Long-Term Survival Following Aortic Valve Replacement: the Influence of Age, Prosthesis-Patient Mismatch and Indexed Effective Orifice Area

BackgroundProsthesis-patient mismatch (PPM) has been linked to reduced long-term survival after aortic valve replacement. We studied the influence of age, PPM and indexed effective orifice area (iEOA) in this setting. MethodsPatients (n=586) subjected to aortic valve replacement were followed up for a mean of 7.8 years (maximum 20 years). The study population was divided into four equivalent groups according to age. Mortality data was extracted from the National Statistics database. Data pertaining to patient body surface area and valve effective orifice area was collected prospectively and mismatch (moderate or severe) was defined according to established values. The Cox proportional hazard model was used to study the effect of age, mismatch and iEOA on survival. The Log Rank test was used to compare survival curves by age groups. ResultsThe incidence of moderate PPM was 24.6%, and of severe PPM 3.9%. Mismatch increased the hazard of death by 31.2% for moderate PPM and 70.3% for severe PPM but did not reach statistical significance. Mean age of patients with mismatch (n=167) was 2.52 years less than in those without (63.35±10.61 versus 65.87±11.69, p=0.016). Age significantly affected survival, increasing the risk of death by 7.3% for every incremental year. Mean iEOA was 0.94±0.15cm2/m2; for every 0.1unit increase in iEOA the risk of death decreased by 8.8%. ConclusionLong-term survival was significantly affected by age at operation. Although mismatch increased hazard of death the effect did not reach statistical significance. A larger iEOA had a significant beneficial effect on survival.

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Long-term survival after Carpentier-Edwards Perimount aortic valve replacement in Western Denmark: a multi-centre observational study

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01506-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Lytfi Krasniqi ◽

Mads P. Kronby ◽

Lars P. S. Riber

Keyword(s):

Risk Factors ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Significant Risk ◽

Valve Prosthesis ◽

Term Survival ◽

Long Term Survival ◽

All Cause Mortality

Abstract Background This study describes the long-term survival, risk of reoperation and clinical outcomes of patients undergoing solitary surgical aortic valve replacement (SAVR) with a Carpentier-Edwards Perimount (CE-P) bioprosthetic in Western Denmark. The renewed interest in SAVR is based on the questioning regarding the long-term survival since new aortic replacement technique such as transcatheter aortic-valve replacement (TAVR) probably have shorter durability, why assessment of long-term survival could be a key issue for patients. Methods From November 1999 to November 2013 a cohort of a total of 1604 patients with a median age of 73 years (IQR: 69–78) undergoing solitary SAVR with CE-P in Western Denmark was obtained November 2018 from the Western Danish Heart Registry (WDHR). The primary endpoint was long-term survival from all-cause mortality. Secondary endpoints were survival free from major adverse cardiovascular and cerebral events (MACCE), risk of reoperation, cause of late death, patient-prothesis mismatch, risk of AMI, stroke, pacemaker or ICD implantation and postoperative atrial fibrillation (POAF). Time-to-event analysis was performed with Kaplan-Meier curve, cumulative incidence function was performed with Nelson-Aalen cumulative hazard estimates. Cox regression was applied to detect risk factors for death and reoperation. Results In-hospital mortality was 2.7% and 30-day mortality at 3.4%. The 5-, 10- and 15-year survival from all-cause mortality was 77, 52 and 24%, respectively. Survival without MACCE was 80% after 10 years. Significant risk factors of mortality were small valves, smoking and EuroSCORE II ≥4%. The risk of reoperation was < 5% after 7.5 years and significant risk factors were valve prosthesis-patient mismatch and EuroSCORE II ≥4%. Conclusions Patients undergoing aortic valve replacement with a Carpentier-Edwards Perimount valve shows a very satisfying long-term survival. Future research should aim to investigate biological valves long-term durability for comparison of different SAVR to different TAVR in long perspective.

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The Prospects of Secondary Moderate Mitral Regurgitation after Aortic Valve Replacement —Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17197335 ◽

2020 ◽

Vol 17 (19) ◽

pp. 7335

Author(s):

Ilija Bilbija ◽

Milos Matkovic ◽

Marko Cubrilo ◽

Nemanja Aleksic ◽

Jelena Milin Lazovic ◽

...

Keyword(s):

Aortic Valve ◽

Mitral Regurgitation ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Meta Analysis ◽

Reverse Remodeling ◽

Term Survival ◽

Long Term Survival

Aortic valve replacement for aortic stenosis represents one of the most frequent surgical procedures on heart valves. These patients often have concomitant mitral regurgitation. To reveal whether the moderate mitral regurgitation will improve after aortic valve replacement alone, we performed a systematic review and meta-analysis. We identified 27 studies with 4452 patients that underwent aortic valve replacement for aortic stenosis and had co-existent mitral regurgitation. Primary end point was the impact of aortic valve replacement on the concomitant mitral regurgitation. Secondary end points were the analysis of the left ventricle reverse remodeling and long-term survival. Our results showed that there was significant improvement in mitral regurgitation postoperatively (RR, 1.65; 95% CI 1.36–2.00; p < 0.00001) with the average decrease of 0.46 (WMD; 95% CI 0.35–0.57; p < 0.00001). The effect is more pronounced in the elderly population. Perioperative mortality was higher (p < 0.0001) and long-term survival significantly worse (p < 0.00001) in patients that had moderate/severe mitral regurgitation preoperatively. We conclude that after aortic valve replacement alone there are fair chances but for only slight improvement in concomitant mitral regurgitation. The secondary moderate mitral regurgitation should be addressed at the time of aortic valve replacement. A more conservative approach should be followed for elderly and high-risk patients.

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