No abstract

From 1965 through 1986 136 patients underwent valve replacement for aortic regurgitation. Mean age was 50 years and male:female ratio 3.7:1. Hospital mortality (HM, less than or equal to 30 days) varied with NYHA classes and digitalis/diuretics treatment (D/D):I (n = 80) 0%, II without D/D (n = 17) 0%, II with D/D (n = 21) 5%, III (n = 55) 7%; and IV (n = 35) 29% (p less than 0.01). Long-term survival was examined for 121 patients who were alive 30 days postoperatively. Five- and 10-year cumulative survival +/- SE were 80 +/- 4% and 66 +/- 6%, respectively. No late deaths were noted for NYHA class I and NYHA class II without D/D; NYHA class II with D/D had survival characteristics comparable to NYHA class III with 10-year survivals of 60%. Patients with acute regurgitation (endocarditis, n = 35) had a 10-year survival +/- SE of 88 +/- 5% compared to 57 +/- 7% for chronic regurgitation (p = 0.05). A Cox regression analysis revealed that ventricular ectopic beats, chronic regurgitation, left ventricular failure, and right ventricular failure were independent risk factors. Presence and different combination of these risk factors identified 5 risk groups (A-E) with 10-year survivals of:A (n = 16) 100%; B (n = 50) 75%; C (n = 37) 63%; D (n = 15) 27%; and E (n = 3) 0% (p less than 0.0001). Minimally symptomatic patients without preoperative medical treatment for congestive heart failure had superior survival characteristics compared to those who received treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Predictability of prosthesis- and sudden heart-related complications was examined in 121 patients who were alive 30 days after valve replacement (1965-86) for aortic regurgitation. A variety of prosthetic valves, mainly mechanical, were used. The Cox regression model was used to identify independent risk factors and to estimate the predicted freedom of events relative to combinations of these risk factors. In the following, linearized event-rates (LER) are given as number of events per 100 patient years +/- standard error. No risk factors could be identified for endocarditis (LER: 0.3 +/- 0.2) or anticoagulant-related hemorrhage (LER: 1.7 +/- 0.6). Only factors underlying deranged preoperative patient and heart status and cardioplegic method, but not the type of prosthetic valve, had predictive influence on the other complications. Predicted 10-year event-freedoms for low- versus high-risk estimate were 98% versus 46% for thromboembolism (LER: 2.1 +/- 0.6), 87% versus 68% for all prosthesis-related complications (LER: 5.0 +/- 0.8), 100% versus 0% for sudden heart-related events (LER: 2.0 +/- 0.5; myocardial infarction and arrhythmia), and 72% versus 38% for combined prosthesis- and sudden heart-related morbidity and mortality (LER: 7.0 +/- 1.0). By deciding to operate early in the course of aortic regurgitation, the rate of these complications may be "actively" reduced, and longevity and life quality of the patients improved.