Short and Long-term Results of Open Heart Surgery in Aortic Valve Disease

Kim, Hyun Sook; Song, Jae Kwan; Lee, Jae Hwan; Kim, Young Hak; Kim, Min Kyu; Kang, Duk Hyun; Kim, Jae Joong; Park, Seong Wook; Park, Seung Jung; Song, Hyun; Lee, Jae Won; Seo, Dong Man; Song, Meong Gun

Abstract

BACKGROUND AND OBJECTIVES
This study sought to investigate operative and late mortality in aortic valve surgery and to identify risk factors for operative and late mortality.
MATERIALS AND METHODS
We examined operative mode, operative and late mortality, and survival rate of aortic valve surgery performed at Asan Medical Center between June 1989 and December 1996.
RESULTS
227 patients (148 men) with a mean age 49+/-15 years underwent aortic valve surgery. Aortic valvular lesions were classified as dominant stenosis (n=66), dominant regurgitation (n=133), and balanced stenoinsufficiency (n=28) according to the echocardiographic findings. Surgical procedures were aortic valve replacement with mechanical prosthesis in 180 (79 %) and with bioprosthesis in 27 (12 %) and aortic valve repair in 20 (9 %). The overall operative mortality was 4.8 %. Bacterial endocarditis and long bypass time were independent factors associated with high operative mortality (p < 0.05). During follow up (mean 33+/-24 months) of operative survivors, there were 9 late deaths, 12 re-do operations, and 11 clinical events (bacterial endocarditis, stroke, major bleeding, and admission for heart failure). There was no single identifiable risk factor for late mortality but age was significantly associated with development of clinical event and late mortality (p < 0.05). One-, Three-, and Seven-years survival rate after successful operation were 98+/-1 %, 96+/-2 %, and 92+/-3 %, respectively. Late clinical event-free survival rate was 67+/-8 % at seven years after aortic valve surgery.
CONCLUSIONS
Aortic valve surgery could be done with low operative and late mortality. Complications related with bacterial endocarditis and long-term anticoagulation therapy following valve replacement surgery still remained high, which needs further improvement.