Long-term outcomes after elective isolated mechanical aortic valve replacement in young adults

Objectives: The aim of this study was to determine long-term survival and clinical outcomes after elective isolated mechanical aortic valve replacement in young adults.

Methods: A clinical observational study was conducted in a cohort of 450 consecutive adults less than 65 years of age who had undergone elective isolated mechanical aortic valve replacement (AVR) between 1997 and 2006. Patients who had undergone previous cardiac surgery, and those undergoing concomitant procedures or urgent surgery were excluded. Follow-up was 93.3%complete with a mean follow-up of 9.1 ± 3.5 years. The primary end point was survival. Life table analyses were used to determine age- and gender-matched general population survival. Secondary end points were reoperation and valve-related complications.

Results: Overall actuarial survival at 1, 5, and 10 years was 98% ± 1%, 95% ± 1%, and 87% ± 1%, respectively, which was lower than expected in the age- and gender-matched general population in Quebec. Actuarial freedom from prosthetic valve dysfunction was 99% ± 0.4%, 95% ± 1%, and 91% ± 1% at 1, 5, and 10 years, respectively. Actuarial freedom from valve reintervention was 98% ± 1%, 96% ± 1%, and 94% ± 1% at 1, 5 and 10 years, respectively. Actuarial survival free from reoperation at 10 years was 82% ± 2%. Actuarial freedom from major hemorrhage was 98% ± 1%, 96% ± 1%, and 90% ± 2% at 1, 5, and 10 years, respectively.

Conclusions: In young adults undergoing elective isolated mechanical AVR, survival remains suboptimal compared with an age- and gender-matched general population. Furthermore, there is a low but constant hazard of prosthetic valve reintervention after mechanical AVR.