Long-term prosthesis-related and sudden cardiac-related complications after valve replacement for aortic stenosis.

Abstract

Predictability of prosthesis-related and sudden cardiac-related complications was examined in 630 patients who were alive 30 days after valve replacement (1965 to 1986) for aortic stenosis. Follow-up totaled 4,072 patient-years. A variety of prosthetic valves, mainly mechanical, were used. The Cox regression model was used to identify independent risk factors and to estimate predicted event-freedoms relative to combinations of these risk factors. There were no risk factors for endocarditis (0.5 +/- 0.1 [number of events per 100 patient-years +/- the standard error]). Except for "other" prosthesis-related complications (0.4 +/- 0.1), adversely influenced by porcine bioprostheses (n = 15) and by the Lillehei-Kaster prosthesis (n = 25), only factors underlying diseased preoperative patient/cardiac status had predictive influence. Predicted 10-year event-freedoms for low-risk versus high-risk estimate were 86% versus 73% for thromboembolism (1.7 +/- 0.2), 95% versus 32% for anticoagulant-related hemorrhage (2.4 +/- 0.2), 69% versus 36% for all prosthesis-related complications (5.0 +/- 0.4), 93% versus 0% for sudden cardiac-related events (myocardial infarction and arrhythmia) (1.8 +/- 0.2), and 66% versus 0.5% for combined prosthesis-related and sudden cardiac-related morbidity and mortality (6.8 +/- 0.4). In 193 patients with coronary arteriography, coronary artery disease was a significant risk factor for each of the complication modalities examined except other prosthesis-related complications, prosthesis replacement, and endocarditis. Deciding to operate early in the course of aortic stenosis might "actively" reduce the rate of these complications.