AORTIC-VALVE REPLACEMENT FOR END-STAGE AORTIC-VALVE DISEASE

To evaluate the outcome of surgical intervention for end-stage aortic valve disease, we carried out a retrospective, longitudinal survey of 85 patients (65 males, 20 females; mean age 53 years) undergoing aorti c valve replacement over a 13-year period. All the patients presented in New York Heart Association (NYHA) class IV in cardiac failure (3 ha d cardiogenic shock and 27 had bacterial endocarditis). In-hospital mo rtality was 9.4 % (8/85) overall. Those with endocarditis had a signif icantly higher mortality, 6/27 (22 %) vs 2/58 (3.4 %), p < 0.01. In-ho spital mortality was not significantly increased in those with renal f ailure, reoperation, simultaneous coronary artery surgery, age > 65 ye ars nor was it related to the predominance of aortic regurgitation or stenosis. After a mean follow-up period of 5.9 years (range 0 to 12.5 years), the overall actuarial survival was 82 % and 74 % at 5 and 10 y ears respectively. For 66 late survivors, the NYHA status improved to class I in 51, to II in 10, to III in 4 patients, and one patient rema ined in class IV. The incidence of paraprosthetic leak, reoperation, t hromboembolism, anticoagulant-related haemorrhage, and endocarditis we re respectively 0.8, 0.8, 1.6, 1.4, and 0.2 per 100 patient-years. Aor tic valve replacement in the patient with end-stage aortic valve disea se is a high-risk procedure, the risk being higher in the presence of endocarditis. The favourable long-term survival, long-term improvement in functional class and the relatively low incidence of valve-related complications justify surgical intervention in such patients, who wou ld otherwise have a very poor prognosis.