Prediction of long-term complications associated with aortic valve prostheses:A 10–17 Year Follow-up

Abstract

Long-term complications following implantation of aortic valve prosthesis were assessed in 139 patients who had survived >30 postoperative days (maximum follow-up 17 years). Most of the prostheses were Starr-Edwards valves (38 silastic ball, SESB, and 96 cloth-covered, SECC). All patients received maintenance coumarin. The rate of thromboembolic complications was 1.6/100 patient-years, without difference between SESB and SECC valves although there were no episodes with SESB from 6 years postoperatively. The overall rate of valve-related complications (VRC)—thromboembolism, hemorrhage, endocarditis, re-replacement, etc.—was 4.2/100 patient-years. High preoperative cardiothoracic index (CTI) significantly increased the incidence of VRC. Preoperative NYHA class III–IV and high CTI similarly influenced the rate of serious VRC(= VRC excluding extremity emboli, epistaxis and subcutaneous bleeding). The valve-and-heart-related morbidity (= VRC including myocardial infarction and pacemaker requirement) was also influenced by preoperative CTI. The long-term complications thus were not exclusively attributable to the prosthesis, but also to preoperative patient-related data.

Key Words:

• heart valve prosthesis
• aortic valve replacement
• thromboembolism
• valve-related complications
• long-term morbidity