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

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.

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.