Circulation, Vol 68, 1149-1162, Copyright © 1983 by American Heart Association
BW Lytle, DM Cosgrove, FD Loop, PC Taylor, CC Gill, LA Golding, M Goormastic and LK Groves
Five hundred consecutive patients underwent aortic valve replacement and
coronary revascularization in the years from 1967 to 1981, with 29 (5.9%)
in-hospital deaths. Current operative mortality (1978-1981) is 3.4%.
Univariate and multivariate analyses were used to identify determinants of
early and late risk. Female sex, aortic insufficiency, and advanced age
increased in-hospital mortality, whereas use of cardioplegia decreased it.
At follow-up of 471 patients who survived hospitalization for 1 to 135
months (mean 41) after surgery, 96 late deaths were documented. Survival
rates were 87%, 80%, and 55%, and event-free survival rates were 80%, 65%,
and 39% at 2, 5, and 10 years after surgery, respectively. The late
survival rate was unfavorably influenced by the presence of moderately or
severely impaired left ventricular function and double-vessel coronary
disease; the rate was enhanced for patients in age group from 50 to 59
years old and was not influenced by the method of myocardial protection.
The event-free survival rate decreased with the presence of moderately or
severely impaired left ventricular function and was enhanced for patients
with New York Heart Association class I or II symptoms before surgery.
Patients with bioprostheses who did not receive anticoagulants had higher
survival and event-free survival rates than did either patients with
bioprostheses who received anticoagulants or patients with mechanical
valves, whether they received anticoagulants or not.
ARTICLES
Replacement of aortic valve combined with myocardial revascularization: determinants of early and late risk for 500 patients, 1967-1981
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