Clinical Results of Aortic Valve Replacement

Na, Kook Joo; Oh, Jeong Woo; Ahn, Byung Hee; Kim, Sang Hyung

Abstract

From August 1986 until June 1995, single aortic valve replacement was performed in 65 patients at the Chonnam National University Hospital. Forthy-eight were male and 17 were female patients, ranging from 19 to 68 years of age (median=43 years). The causes of the valve lesions were rheumatic in 29 patients (44.6%), bicuspid aortic valve in 6 patients (6.2%), endocarditis in 6 patients (6.2%), unknown in others. Concomitant surgical procedures were performed in 10 patients: repair of congenital defect in 5, pericardiectomy in 1, coronary artery bypass grafting in 1, noncoronary sinus plication in 1, Valsalva sinus aneurysmectomy in 1, subaortic membrane resection in 1. Used valves were St. Jude-Medical valve in 42, Duromedics valve in 22, Bjork-Shiley valve in 2, Carpentier-Edward valve in 1. There were 3 hospital deaths (4.6%), and 2 late deaths (3.2%). Follow-up was 95.2% complete. The 10-year acturial survival rate was 85.3%. Postoperative complications were low cardiac output in 8, arrythmia in 5, valve related hemolysis in 1, cerebral infarction in 1, and gastrointestinal bleeding in 2. Reoperation was performed in 4 for surgical bleeding, in 3 for paravalvular leak. The mean improvement in New York Heart Association functional class is from 2.79+-0.66 preoperatively to 1.25+-0.49 postoperatively (p<0.001) The change of cardiothoracic ratio from preoperative to postoperative is 0.57+-0.06 to 0.54+-0.05 (p<0.05). The left ventricular ejection fraction change is not significant perioperatively. There are no mechanical failures. This early and intermediate-term follow-up suggests that in adults in whom valve repair is not possible, the mechanical valve is a reliable and durable prosthesis with good hemodynamic function and a low rate of thromboembolic event.