Perioperative and long-term outcomes following aortic valve replacement: a population cohort study of 4124 consecutive patients

McLean, R.C., Briggs, A.H. , Slack, R., Zamvar, V., Berg, G.A., El-Shafei, H., Oldroyd, K.G. and Pell, J.P. (2011) Perioperative and long-term outcomes following aortic valve replacement: a population cohort study of 4124 consecutive patients. European Journal of Cardio-Thoracic Surgery, 40(6), pp. 1508-1514. (doi:10.1016/j.ejcts.2011.01.088)

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Abstract

Objective: Because of increasing life expectancy, more patients require valve replacement for aortic stenosis. We aimed to determine perioperative and long-term outcomes, the factors associated with these and whether they have changed over time. Methods: We undertook a retrospective cohort study of all 4124 patients, who underwent isolated, primary aortic valve replacement in Scotland between April 1996 and March 2009 inclusive. Results: Annual operations increased by 68%, from 261 to 439. The overall risk of dying within 30 days, 5 years and 10 years was 3.4%, 19.9% and 38.5%, respectively. Over 10 years’ follow-up, 4.4% underwent further valve surgery, 7.9% suffered a stroke and 5.3% a myocardial infarction. Age, renal impairment and urgency were predictors of both perioperative and long-term death. Perioperative death was associated with left-ventricular impairment and long-term death with respiratory disease, diabetes and deprivation. Over the 13 years, there was an increase in median age (from 66 to 69 years, p < 0.001), diabetes (from 1.9% to 12.6%, p < 0.001), hypertension (from 26.4% to 56.1%, p < 0.001), cerebrovascular disease (from 3.7% to 9.8%, p < 0.001), respiratory disease (from 6.6% to 9.7%, p = 0.020) and previous myocardial infarction (from 0.6% to 5.8%, p < 0.001), but the risk of perioperative death fell from 6.5% to 3.1% (odds ratio (OR) 0.87, 95% confidence interval (CI) 0.83, 0.92, p < 0.001) per year. Conclusions: Patients undergoing aortic valve replacement have a poor risk profile. Over time, their numbers, age and co-morbidity have increased. In spite of these, there has been a significant reduction in the risk of perioperative death.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Briggs, Professor Andrew and Pell, Professor Jill and Oldroyd, Dr Keith
Authors: McLean, R.C., Briggs, A.H., Slack, R., Zamvar, V., Berg, G.A., El-Shafei, H., Oldroyd, K.G., and Pell, J.P.
Subjects:R Medicine > RC Internal medicine
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:European Journal of Cardio-Thoracic Surgery
ISSN:1010-7940
ISSN (Online):1873-734X
Published Online:13 April 2011

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