THIRTY YEARS EXPERIENCE WITH HEART VALVE SURGERY: ISOLATED AORTIC VALVE REPLACEMENT


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Abstract

Background:Thirty years have elapsed since the commencement of open-heart surgery in South Australia. A retrospective study was performed to evaluate mortality and complication rates and to identify associated with poor outcomes in all patients who underwent prosthetic aortic valve replacement during this period.Methods:Questionnaires and personal contact have been to generate a combined database of pre-operative and post-operative information and long-term follow-up on 1322 patients who underwent isolated aortic replacement at the Cardio-Thoracic Surgical Unit of the Royal Adelaide Hospital between 1963 and 1992.Results:Complete survival follow-up data were obtained for 94% (1241) of the patients. The Bjork-Shiley valve was used in 66% (875) of the patients, a Starr-Edwards prosthesis in 31% (421), a St Jude in 2% (26), and only 0.7%(9) bioprosthetic valves were inserted. The hospital mortality rate for the 30-year period was 2.9%. Progressively older and less fit patients have undergone surgery in recent years. The long-term survival with aortic stenosis and aortic incompetence was not significantly different. Long-term survival was significantly shorter for patients with higher New York Heart Association (NYHA) functional classifications, and for patients in pre-operative fibrillation. Pre-operative dyspnoea was significantly improved following aortic valve replacement. The rates of postoperative haemorrhagic and embolic complications were low by comparison with other published series.Conclusions:Aortic valve replacement can be performed with low hospital mortality and complication rates, and significant symptomatic improvement can be expected. Aortic valve recipients have a favourable outcome compared with an age- and sex-matched population, and risk factors that determine long-term can be identified pre-operatively.

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