| Isolated Aortic Valve Replacement in Patients with Small Aortic Annulus-A High-Risk Group on Long-Term Follow-Up. | |
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MedLine Citation:
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PMID: 23258763 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Background Patients with small aortic annulus undergoing isolated aortic valve replacement face an often underestimated surgical risk. We describe initial clinical results and long-term follow-up of this particular high-risk group.Methods Between January 1998 and December 2004, 148 consecutive patients with small aortic annulus underwent isolated aortic valve replacement by implantation of a Mitroflow Aortic Pericardial Heart Valve (Sorin S.p.A., Milano, Italy) 19 or 21 mm bioprostheses. Mean age was 75.4 ± 6.2 years. Female gender, obesity, and multiple comorbidities were predominant. Mean logistic euroSCORE for mortality was 18.5 ± 2.3%. Follow-up time was 7.2 ± 2.0 years, with a total of 1066 patient years.Results Postoperative course and outcome during follow-up were strongly influenced by extracardiac morbidities. Hospital mortality was 6.1%, 5-year survival 71.9%, and 10-year survival 40.9%. Most patients (70.0%) died because of extracardiac reasons. Significant reasons for death were age, pre-existing atrial fibrillation, diabetes mellitus type 2, chronic renal failure, extracardiac vascular disease, history of stroke, and preoperative presentation at Canadian Cardiovascular Society class III and IV (p < 0.05). Freedom from valve-related reoperation was 99.1% at 5 years and 93.4% at 10 years. Prosthesis-patient mismatch occurred in 12.2% and was not affected with any adverse outcome (p = nonsignificant). Echocardiographic data demonstrated a significant reduction of mean transvalvular gradients in all patients (61.2 ± 19.7 mm Hg preoperatively; 18.0 ± 8.0 mm Hg during follow-up; p < 0.05). All patients reported a significant improvement in New York Heart Association functional class (p < 0.05).Conclusion Patients with small aortic annulus are predominantly small, obese, and old-aged females with multiple comorbidities. Mitroflow valve avoids prosthesis-patient mismatch and provides excellent hemodynamics. Observed long-term results were disappointing, but they were mainly limited by extracardiac comorbidities and advanced age. |
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Authors:
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Manuel Wilbring; Konstantin Alexiou; Elisabeth Schumann; Klaus Matschke; Sems Malte Tugtekin |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-12-20 |
Journal Detail:
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Title: The Thoracic and cardiovascular surgeon Volume: - ISSN: 1439-1902 ISO Abbreviation: Thorac Cardiovasc Surg Publication Date: 2012 Dec |
Date Detail:
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Created Date: 2012-12-21 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7903387 Medline TA: Thorac Cardiovasc Surg Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Georg Thieme Verlag KG Stuttgart · New York. |
Affiliation:
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Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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