INFLUENCE OF CORONARY-ARTERY BYPASS AND AGE ON CLINICAL-PERFORMANCE AFTER AORTIC AND MITRAL-VALVE REPLACEMENT WITH BIOLOGICAL AND MECHANICAL PROSTHESES
Wre. Jamieson et al., INFLUENCE OF CORONARY-ARTERY BYPASS AND AGE ON CLINICAL-PERFORMANCE AFTER AORTIC AND MITRAL-VALVE REPLACEMENT WITH BIOLOGICAL AND MECHANICAL PROSTHESES, Circulation, 92(9), 1995, pp. 101-106
The influence of prosthetic type, age, and coronary artery bypass graf
ting (CABG) on valve-related complications by valve position was evalu
ated in a population of 2353 bioprosthesis patients (mean age, 66.5 ye
ars; range, 13 to 89 years) and in a population of 1112 mechanical pro
sthesis patients (mean age, 59.1 years; range, 13 to 91 years). The fo
llow-up was complete to 96% and 98%, respectively, for the bioprosthes
is and mechanical prosthesis groups. The patient groups were evaluated
by actuarial assessment of survival and valve complications and compo
sites. Preoperative factors were evaluated for determination of signif
icant independent predictors by multivariate; proportional-hazard regr
ession analysis. CABG was an influential factor in the actuarial analy
sis. Survival was superior for aortic mechanical replacements without
CABG and for mitral replacements, both biological and mechanical, with
out CABG (P<.05). The freedom from thromboembolism (TE) and antithromb
oembolic hemorrhage (ATH) was greater for biological prostheses with a
nd without CABG for aortic replacements (P<.05) but not for mitral rep
lacements (P=NS). The freedom from valve-related mortality was not inf
luenced by CABG for either position (P=NS). The freedom from valve-rel
ated reoperation was greater for biological prostheses with CABG than
without CABG for both aortic and mitral replacements (P<.05). The eval
uation of covariates as independent predictors revealed CABG to be a n
onpredictor for aortic valve replacement (AVR) (P=NS) but a predictor
of survival and valve-related reoperation for mitral valve replacement
(MVR) (P<.05). With AVR, biological prostheses predicted greater free
dom from valve-related mortality and TE and ATH (P<.05) and for MVR fo
r TE and ATH (P<.05). Valve position was not a predictor otherwise (P=
NS). Advancing age was a significant covariate for AVR for all areas o
f assessment. Advancing age for MVR provided a lower rate of survival
and greater freedom from valve-related mortality and reoperation (P<.0
5). The clinical performance of valvular prostheses is influenced to a
greater degree by valve type and age than by CABG.