What Can We Learn from the Past by Means of Very Long-Term Follow-Up after Aortic Valve Replacement?

Abstract

Background: Studies on very long-term outcomes after aortic valve replacement are sparse. Methods: In this retrospective cohort study, long-term outcomes during 25.1 ± 2.8 years of follow-up were determined in 673 patients who underwent aortic valve replacement with or without concomitant coronary artery bypass surgery for severe aortic stenosis and/or regurgitation. Independent predictors of decreased long-term survival were determined. Cumulative incidence rates of major adverse events in patients with a mechanical versus those with a biologic prosthesis were assessed, as well as of major bleeding events in patients with a mechanical prosthesis under the age of 60 versus those above the age of 60. Results: Impaired left ventricular function, severe prosthesis–patient mismatch, and increased aortic cross-clamp time were independent predictors of decreased long-term survival. Left ventricular hypertrophy, a mechanical or biologic prosthesis, increased cardiopulmonary bypass time, new-onset postoperative atrial fibrillation, and the presence of symptoms did not independently predict decreased long-term survival. The risk of major bleeding events was higher in patients with a mechanical in comparison with those with a biologic prosthesis. Younger age (under 60 years) did not protect patients with a mechanical prosthesis against major bleeding events. Conclusions: Very long-term outcome data are invaluable for careful decision-making on aortic valve replacement.

The Konno procedure to treat ­prosthesis-patient mismatch and complex left ventricular outflow tract obstruction in adult patients

“…While some authors found PPM to be associated with adverse early and/or late outcome, others did not find any negative influence [3][4][5][6][7][8][9][10][11][12]. In addition, PPM may also preclude regression of left ventricular hypertrophy [13,14].…”

“…PPM is not an uncommon finding following surgical aortic valve replacement (SAVR), as it is described in up to 20-30% of the cases in series following surgical but also transcatheter aortic valve replacement (TAVR) [1][2][3][4][5][6][7].…”