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Long-term follow-up of morbidity and mortality after aortic valve replacement with a mechanical valve prosthesis

Kvidal, P; Bergström, R; Malm, T LU and Ståhle, E (2000) In European Heart Journal 21(13). p.111-1099
Abstract

AIMS: The aim of this study was to determine the incidence of valve-related complications in patients with a mechanical aortic valve prosthesis and to identify risk factors for an adverse outcome.

METHODS AND RESULTS: In the 424 patients, event-free survival rates 5 and 10 years after aortic valve replacement were 62% and 37%, respectively. The linearized incidence of thromboembolic events was 4.4% per patient-year, and of anticoagulant-related haemorrhage 8.5% per patient-year. Advanced NYHA functional class, atrial fibrillation, pure aortic regurgitation and thromboembolism prior to surgery decreased event-free survival. A history of pre-operative thromboembolism increased the risk for a first embolic event after aortic valve... (More)

AIMS: The aim of this study was to determine the incidence of valve-related complications in patients with a mechanical aortic valve prosthesis and to identify risk factors for an adverse outcome.

METHODS AND RESULTS: In the 424 patients, event-free survival rates 5 and 10 years after aortic valve replacement were 62% and 37%, respectively. The linearized incidence of thromboembolic events was 4.4% per patient-year, and of anticoagulant-related haemorrhage 8.5% per patient-year. Advanced NYHA functional class, atrial fibrillation, pure aortic regurgitation and thromboembolism prior to surgery decreased event-free survival. A history of pre-operative thromboembolism increased the risk for a first embolic event after aortic valve replacement (relative hazard [RH] 3.2), but was even more strongly associated with the risk for repeated events (> or =2 events, RH 5.4). After each thromboembolic episode that occurred, the risk for a subsequent one was increased. The risk for at least one, and up to three or more haemorrhages was increased in patients with a pre-operative history of bleeding (RH 3.3-5.1) and of atrial fibrillation (RH 1.8-3.9). The risk for a subsequent event was increased by a history of repeated haemorrhages, a short interval since previous bleeding, and high age.

CONCLUSIONS: There were few factors strongly related to valve related morbidity. However, previous bleedings and previous thromboembolism were powerful risk factors for repeated events.

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published
subject
keywords
Adolescent, Adult, Aged, Anticoagulants/adverse effects, Aortic Valve, Biocompatible Materials, Cause of Death, Child, Disease-Free Survival, Female, Follow-Up Studies, Heart Valve Diseases/surgery, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation/mortality, Humans, Incidence, Intracranial Embolism and Thrombosis/etiology, Male, Middle Aged, Platelet Aggregation Inhibitors/adverse effects, Postoperative Hemorrhage/chemically induced, Prospective Studies, Prosthesis Failure, Survival Rate, Sweden/epidemiology
in
European Heart Journal
volume
21
issue
13
pages
13 pages
publisher
Oxford University Press
external identifiers
  • scopus:0034077473
ISSN
0195-668X
DOI
10.1053/euhj.2000.1862
language
English
LU publication?
no
id
edb9ec69-09b0-4ce1-9bbf-da6405e0c1b6
date added to LUP
2018-12-05 14:55:54
date last changed
2019-06-04 03:51:46
@article{edb9ec69-09b0-4ce1-9bbf-da6405e0c1b6,
  abstract     = {<p>AIMS: The aim of this study was to determine the incidence of valve-related complications in patients with a mechanical aortic valve prosthesis and to identify risk factors for an adverse outcome.</p><p>METHODS AND RESULTS: In the 424 patients, event-free survival rates 5 and 10 years after aortic valve replacement were 62% and 37%, respectively. The linearized incidence of thromboembolic events was 4.4% per patient-year, and of anticoagulant-related haemorrhage 8.5% per patient-year. Advanced NYHA functional class, atrial fibrillation, pure aortic regurgitation and thromboembolism prior to surgery decreased event-free survival. A history of pre-operative thromboembolism increased the risk for a first embolic event after aortic valve replacement (relative hazard [RH] 3.2), but was even more strongly associated with the risk for repeated events (&gt; or =2 events, RH 5.4). After each thromboembolic episode that occurred, the risk for a subsequent one was increased. The risk for at least one, and up to three or more haemorrhages was increased in patients with a pre-operative history of bleeding (RH 3.3-5.1) and of atrial fibrillation (RH 1.8-3.9). The risk for a subsequent event was increased by a history of repeated haemorrhages, a short interval since previous bleeding, and high age.</p><p>CONCLUSIONS: There were few factors strongly related to valve related morbidity. However, previous bleedings and previous thromboembolism were powerful risk factors for repeated events.</p>},
  author       = {Kvidal, P and Bergström, R and Malm, T and Ståhle, E},
  issn         = {0195-668X},
  keyword      = {Adolescent,Adult,Aged,Anticoagulants/adverse effects,Aortic Valve,Biocompatible Materials,Cause of Death,Child,Disease-Free Survival,Female,Follow-Up Studies,Heart Valve Diseases/surgery,Heart Valve Prosthesis,Heart Valve Prosthesis Implantation/mortality,Humans,Incidence,Intracranial Embolism and Thrombosis/etiology,Male,Middle Aged,Platelet Aggregation Inhibitors/adverse effects,Postoperative Hemorrhage/chemically induced,Prospective Studies,Prosthesis Failure,Survival Rate,Sweden/epidemiology},
  language     = {eng},
  number       = {13},
  pages        = {111--1099},
  publisher    = {Oxford University Press},
  series       = {European Heart Journal},
  title        = {Long-term follow-up of morbidity and mortality after aortic valve replacement with a mechanical valve prosthesis},
  url          = {http://dx.doi.org/10.1053/euhj.2000.1862},
  volume       = {21},
  year         = {2000},
}