Nine-year routine clinical experience of aortic valve replacement with ATS mechanical valves.

BACKGROUND AND AIM OF THE STUDY

The study aim was to update the authors' experience with aortic valve replacement (AVR) using the ATS mechanical prosthesis in terms of early and long-term outcome in routine practice.

METHODS

This retrospective analysis was extracted from clinical data available between April 1996 and February 2005, of AVR with the ATS Medical prosthesis in 510 consecutive patients (345 men, 165 women; mean age 62 +/- 12 years), of whom 296 underwent isolated AVR (iAVR). Concomitant surgical procedures included coronary artery bypass grafting (AVR+CABG, n = 47), mitral valve procedure (AVR+MVP, n = 59), ascending aortic replacement (AVR+AAR, n = 74) and other procedures (AVR+Miscellaneous, n = 34). Early and late morbidity/mortality were analyzed for the entire group in case of emergency surgery, preoperative low left ventricular ejection fraction (LVEF <50%) and in elderly people (age > or = 70 years).

RESULTS

The overall 30-day mortality was 7.2% (iAVR 4.7%; AVR+CABG 4%; AVR+MVP 8.5%; AVR+AAR 2.9%; AVR+Miscellaneous 14.7%). The five- and nine-year global survival rates were respectively 81.14 +/- 2.4% and 67.02 +/- 10.4%. Long-term survival was lower in case of emergency surgery (p = 0.001), when the preoperative LVEF was <50% (p = 0.03), and when patients were aged > or = 70 years (p = 0.0005). Linearized postoperative valve-related death was 1.1% per patient-year (pt-yr). However, nine years' freedom from valve-related death and valve-related morbidity were not significantly different when the patient age was > or = 70 years. The linearized rate for postoperative thromboembolism complication was 0.4% per pt-yr, and that for postoperative bleeding complication 0.63% per pt-yr. There were two perivalvular leaks (0.05%/pt-yr). Neither valve thrombosis, structural dysfunction nor endocarditis were observed.

CONCLUSION

The findings of this retrospective study point to a globally very good performance of the ATS valve, and essentially similar to previously reported results with these and other available mechanical valves.