The Ionescu-Shiley® Xenobioprosthesis as an Aortic Valve Substitute in Patients 66 Years of Age and Older
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.
KeywordsValve Replacement Infective Endocarditis Aortic Valve Replacement Hospital Death Late Mortality
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