Advertisement

The Ionescu-Shiley® Xenobioprosthesis as an Aortic Valve Substitute in Patients 66 Years of Age and Older

  • L. Gonzalez-Lavin
  • L. B. McGrath
  • S. Amini
  • B. Lewis
  • J. Gonzalez-Lavin
  • S. Chi

Abstract

A cohort of 107 patients, aged 66 years and over, from a series of 240 patients receiving an IONESCU-SHILEY® bioprosthesis (ISBPV) in the aortic position, were studied in isolation. The procedures were performed from 1977 to 1983. The mean age of this group was 72.7 ± 5.2 years (range: 66 to 88 years; median: 71 years). The average preoperative New York Heart Association (NYHA) Functional Class was HI. Concomitant procedures were performed in 54 patients (50.5%). Hospital mortality was 8.4% (n = 9). Univariate analysis revealed that risk factors for hospital mortality were older age (p = 0.04), higher preoperative NYHA Class (p = 0.06), and earlier year of operation (p = 0.05). Patients dismissed from the hospital were followed for a total of 4652.35 months (mean 43.5 ± 2.5). Follow-up was 100% complete. Late mortality occurred at a rate of 7.7% per patient-year. Significant univariate risk factors for late mortality were earlier year of operation (p = 0.03) and concomitant procedures (p = 0.06). Late mortality due to valve-related complications was 0.8% per patient-year. Where numbers permitted, univariate and multivariate risk factors were assessed for each valve-related complication. Pertinent findings were abstracted. The univariate risk factor for intrinsic valve failure was elective operation (p = 0.04); an indicator was younger age, for example, 69 vs. 72.9 years (p = 0.08). The only multivariate risk factor for intrinsic valve failure was previous operation (p = 0.04). Multivariate risk factors for any valve-related complication were younger age (p = 0.04 for 68.9 years vs. 73.2 years), previous operation (p = 0.04), and concomitant procedures (p = 0.01). Our conclusion is that results of aortic valve replacement with ISBPV in older patients are good. Older age increases the risk of hospital death. Actuarial survival and freedom from valve-related events are good.

Keywords

Valve Replacement Infective Endocarditis Aortic Valve Replacement Hospital Death Late Mortality 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Walker DK, Scotten LN, Modi VJ, et al. In vitro assessment of mitral valve prostheses. J Thorac Cardiovasc Surg 1980; 79:680.PubMedGoogle Scholar
  2. 2.
    Wright JTM. Hydrodynamic evaluation of tissue valves. In Ionescu MI (ed): Tissue Heart Valves. Butterworth, London 1979; pp 29–88.Google Scholar
  3. 3.
    Rainer WG, Christopher RA, Sadler TR Jr, et al. Dynamic behavior of prosthetic aortic tissue valves as viewed by high-speed cinematography. Ann Thorac Surg 1979; 28:274.PubMedCrossRefGoogle Scholar
  4. 4.
    Tandon AP, Smith DR, Mary DAS, et al. Sequential hemodynamic studies in patients having aortic valve replacement with the Ionescu-Shiley pericardial valve. Ann Thorac Surg 1977; 24:149.PubMedCrossRefGoogle Scholar
  5. 5.
    Gonzalez-Lavin L, Tandon AP, Chi S, Blair TC, McFadden PM, Lewis B, Daughters G, Ionescu MI. Risk of thromboembolism and hemorrhage following mitral valve replacement. A comparative analysis between porcine xenograft and Ionescu-Shiley bovine pericardial valves. J Thorac Cardiovasc Surg 1984; 87:340.PubMedGoogle Scholar
  6. 6.
    Gonzalez-Lavin L, Chi S, Lewis B, et al. An 8-year experience with the standard Ionescu-Shiley pericardial valve in the aortic position. In Bodnar E and Yacoub M (eds): Biologic Bioprosthetic Valves: Proceedings of the Third International Symposium. Yorke Medical Books, New York 1986; pp 199–213.Google Scholar
  7. 7.
    Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. Am Stat Assoc J 1958; 53:457–481.CrossRefGoogle Scholar
  8. 8.
    Cox, DR. Regression models and life tables (with discussion). J Roy Stat Soc B 1972; 34:187–220.Google Scholar
  9. 9.
    Mantel N, Haenszel W. Statistical aspects of the analyses of the data from retrospective studies of disease. J Nat Canc Inst 1959; 22:719–748.Google Scholar
  10. 10.
    Fleiss JL. Statistical Methods for Rates and Proportions. John Wiley and Sons, New York 1973.Google Scholar
  11. 11.
    Cox DR. Analysis of Binary Data. Methuen and Co., London 1970.Google Scholar
  12. 12.
    Lee ET. Statistical Methods for Survival Data Analysis. Lifetime Learning Publications, Belmont 1980.Google Scholar
  13. 13.
    Borkon, AM, Mcintosh CL, Von Reuden TJ, et al. Mitral valve replacement with the Hancock bioprosthesis: Five- to ten-year follow-up. Ann Thorac Surg 1981; 32:127.PubMedCrossRefGoogle Scholar
  14. 14.
    Johnson D, Gonzalez-Lavin L. Myocardial infarction secondary to calcific embolization. An unusual complication of xenobioprosthetic degeneration. Ann Thorac Surg 1986; 42:102.PubMedCrossRefGoogle Scholar
  15. 15.
    Johnson DE, Billingham ME, Gonzalez-Lavin L. Pathologic changes in dysfunctional Ionescu-Shiley bovine pericardial heterograft valves. In Cardiac Prostheses Symposium HI. Shiley, Inc., Irvine, 1987; p 135–45.Google Scholar
  16. 16.
    Schoen FJ, Fernandez J, Gonzalez-Lavin L, Cernaianu A. Causes of failure and pathologic findings in surgically removed bovine Ionescu-Shiley standard pericardial heart valve bioprostheses: emphasis on progressive structural deterioration. Circulation 1987; 76–111–618.Google Scholar
  17. 17.
    Gonzalez-Lavin L, McGrath LB, Fernandez J, Quinlan WC. Strut fracture and other related valve-related events following valve replaceemnt with the 60° Convexo-Concave Björk-Shiley prosthesis. Circulation 1986; 74:11–337.Google Scholar

Copyright information

© Kluwer Academic Publishers 1989

Authors and Affiliations

  • L. Gonzalez-Lavin
  • L. B. McGrath
  • S. Amini
  • B. Lewis
  • J. Gonzalez-Lavin
  • S. Chi

There are no affiliations available

Personalised recommendations