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Eur J Cardiothorac Surg 2005;27:425-433
© 2005 Elsevier Science NL
a Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin Street, Suite 3403, Ottawa, Ont., Canada K1Y 4W7
b Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont., Canada
Received 9 September 2004; received in revised form 22 November 2004; accepted 1 December 2004.
* Corresponding author. Address: Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin Street, Suite 3403, Ottawa, Ont., Canada K1Y 4W7. Tel.: +1 613 761 4893; fax: +1 613 761 4713. (E-mail: mruel{at}ottawaheart.ca).
Objectives: To examine the multiple impacts of valve replacement on the lives of young adults. Methods: Patients (N=500) between age 18 and 50 who had aortic valve replacement (AVR) and/or mitral valve replacement (MVR) with contemporary prostheses were followed annually. Events, functional status, and quality of life were examined with regression models. Results: Median follow-up was 7.1±5.3 years (maximum 26.7 years). Five, 10, and 15-year survival was 92.7±1.7, 88.3±2.4 and 80.1±4.7% after AVR, and 93.1±2.3, 79.5±4.3 and 71.5±5.4% after MVR, respectively. Survival decreased with concomitant coronary disease (hazard ratio (HR): 4.5) and preoperative LV grade (HR: 2.0/grade increase) in AVR patients, and with atrial fibrillation (HR: 5.5), coronary disease (HR: 5.7), preoperative left atrial diameter (HR: 3.0/cm increase) and NYHA class (HR: 2.1/class increase) in MVR patients. Despite reoperation, late survival was equivalent between bioprostheses and mechanical valves in both implant positions. The ten-year cumulative incidence of embolic stroke was 6.3±2.4% for mechanical AVR patients, 6.4±2.9% for bioprosthetic AVR patients, 12.7±3.9% for mechanical MVR patients, and 3.1±3.1% for bioprosthetic MVR patients. Atrial fibrillation (HR: 2.8) and smoking (HR: 4.0) were risk factors for stroke in MVR patients. In AVR patients, SF-12 physical scores, freedom from recurrent heart failure, and freedom from disability were significantly higher in bioprosthetic than mechanical valve patients. Career or income limitations were more often subjectively linked to a mechanical prosthesis in both implant positions. Conclusions: Late outcomes of modern prosthetic valves in young adults remain suboptimal. Bioprostheses deserve consideration in the aortic position, as mechanical valves are associated with lower physical capacity, a higher prevalence of disability, and poorer disease perception. Early surgical referral and atrial fibrillation surgery may improve survival after MVR.
Key Words: Follow-up studies • Prognosis • Prosthesis • Valves
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