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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2003 December;44(6):701-6

language: English

Role of age, gender and association of CABG on long-term results after aortic valve replacement with a Carpentier-Edwards bioprosthesis in the elderly

Mistiaen W. 1, Van Cauwelaert Ph. 2, Sys S.U. 3, Muylaert Ph. 2, Harrisson F. 1, Bortier H. 1

1 Labor­a­to­ries of ­Anatomy and Embryology Uni­ver­sity of Ant­werp, Ant­werp, Bel­gium
2 Depart­ment of Car­di­o­vas­cular Sur­gery Mid­del­heim Hos­pital, Ant­werp, Bel­gium
3 Depart­ment of Phys­iology, Bio­chem­istry and Bio­met­rics Faculty of Vet­e­ri­nary Med­i­cine Uni­ver­sity of ­Ghent, Merel­beke, Bel­gium

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Aim. The ­problem of post­op­er­a­tive ­sudden ­death and the ­effect of age, ­gender and asso­ci­a­tion of cor­o­nary ­artery ­bypass ­grafting ­were ­studied ­after implan­ta­tion of a bio­pros­thetic ­valve in ­aortic posi­tion.
­Methods. ­Design: ret­ro­spec­tive inves­ti­ga­tion ­during 13 ­year. Set­ting: gen­eral hos­pital. ­Patients: 500 ­mostly symp­to­matic ­patients who ­received ­this bio­pros­thesis had a ­follow-up of 2 022 patient-­year for 499 ­patients. Inter­ven­tion: ­aortic ­valve replace­ment ­with a Car­pentier-­Edwards per­i­car­dial pros­thesis. Meas­ures: hos­pital com­pli­ca­tions and mor­tality, ­long-­term mor­tality ­with ­focus on ­sudden ­death and its ­risk fac­tors, ­valve ­related com­pli­ca­tions and ­other car­diac ­events.
­Results. ­Within the hos­pital: ­atrial fib­ril­la­tion was the ­most fre­quent com­pli­ca­tion, for ­which ­only ­gender had an ­effect (p=0.014). The ­most occur­ring ­valve ­related com­pli­ca­tions ­were ­thrombo-­embolic ­events. Mor­tality was ­adversely ­affected by ­male ­gender (p=0.040). ­Long-­term ­results: ­thrombo-­embolic ­events ­were the ­most impor­tant ­valve ­related com­pli­ca­tions. ­These ­events and hae­mor­rhage, endo­car­ditis and reop­er­a­tion ­rate ­were not ­affected by the asso­ci­a­tion of a ­CABG. Uni­var­iate anal­ysis in ­patients ­over 73 ­showed ­that the ­need for ­CABG sig­nif­i­cantly ­increased ­global mor­tality (p=0.0001), occur­rence of car­diac ­fatality (p=0.0003) and con­ges­tive ­heart ­failure (p=0.0036). Non-­valve ­related fac­tors ­seemed ­most respon­sible for post­op­er­a­tive ­sudden ­death.
Con­clu­sion. Age, ­male ­gender and the asso­ci­a­tion of a ­CABG ­remain impor­tant deter­mi­nants for post­op­er­a­tive sur­vival, but not for the occur­rence of ­valve ­related com­pli­ca­tions. ­Sudden ­death ­seems not ­always ­related to the ­valve pros­thesis, but is as ­such clas­si­fied by con­ven­tion.

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