Document Detail

Isolated aortic valve replacement in patients with small aortic annulus-a high-risk group on long-term follow-up.
MedLine Citation:
PMID:  23258763     Owner:  NLM     Status:  MEDLINE    
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 1,066 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.
Manuel Wilbring; Konstantin Alexiou; Elisabeth Schumann; Klaus Matschke; Sems Malte Tugtekin
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Publication Detail:
Type:  Journal Article     Date:  2012-12-20
Journal Detail:
Title:  The Thoracic and cardiovascular surgeon     Volume:  61     ISSN:  1439-1902     ISO Abbreviation:  Thorac Cardiovasc Surg     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-08-06     Completed Date:  2014-03-13     Revised Date:  2014-11-03    
Medline Journal Info:
Nlm Unique ID:  7903387     Medline TA:  Thorac Cardiovasc Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  379-85     Citation Subset:  IM    
Copyright Information:
Georg Thieme Verlag KG Stuttgart · New York.
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MeSH Terms
Aged, 80 and over
Aortic Valve / physiopathology,  surgery*,  ultrasonography
Chi-Square Distribution
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation* / adverse effects,  instrumentation,  mortality
Hospital Mortality
Kaplan-Meier Estimate
Logistic Models
Middle Aged
Multivariate Analysis
Postoperative Complications / mortality,  surgery
Prosthesis Design
Risk Factors
Time Factors
Treatment Outcome
Comment In:
Thorac Cardiovasc Surg. 2014 Sep;62(6):503-4   [PMID:  24343378 ]
Thorac Cardiovasc Surg. 2014 Sep;62(6):504

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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