30 YEARS EXPERIENCE WITH HEART-VALVE SURGERY - ISOLATED AORTIC-VALVE REPLACEMENT

Background: Thirty years have elapsed since the commencement of open-h eart surgery in South Australia. A retrospective study was performed t o evaluate mortality and complication rates and to identify factors as sociated with poor outcomes in all patients who underwent prosthetic a ortic valve replacement during this period. Methods: Questionnaires an d personal contact have been used to generate a combined database of p re-operative and post operative information and long-term follow-up on 1322 patients who underwent isolated prosthetic aortic valve replacem ent at the Cardio-Thoracic Surgical Unit of the Royal Adelaide Hospita l between 1963 and 1992. Results: Complete survival follow-up data wer e obtained for 94% (1241) of the patients. The Bjork-Shilep valve was used in 66% (875) of the patients. a Starr-Edwards prosthesis in 31% ( 412), a St Jude prosthesis in 2% (26), and only 0.7% (9) bioprosthetic valves were inserted. The hospital mortality rate for the 30-year per iod was 2.9%. Progressively older and less fit patients have undergone surgery in recent years. The long-term survival of patients with aort ic stenosis and aortic incompetence was not significantly different. L ong-term survival was significantly shorter for patients with higher N ew York Heart Association (NYHA) functional classifications, and for p atients in pre-operative atrial fibrillation. Pre-operative dyspnoea w as significantly improved following aortic valve replacement. The rate s of postoperative haemorrhagic and embolic complications were low by comparison with other published series. Conclusions: Aortic valve repl acement can be performed with low hospital mortality and complication rates, and significant symptomatic improvement can be expected. Aortic valve recipients have a favourable prognostic outcome compared with a n age- and sex-matched population, and risk factors that determine lon g-term survival can be identified pre-operatively.