Late results after valve surgery

The analysis of survival rates of patients following valve replacement relative to age and sex matched populations have shown an impaired prognosis in all but a minority.1 In patients older than 65 years undergoing aortic valve replacement for aortic stenosis, relative survival is “normalised” after the first postoperative year, but in all other indications an excess late mortality has been observed in surgical patients. Long term follow up studies consistently report better survival rates in patients undergoing aortic rather than mitral valve replacement, with 10 year actuarial survival rates of approximately 65% for aortic valve replacement, 55% for mitral valve replacement, and 55% for double (aortic and mitral) valve replacement. Late mortality is greater when surgery is undertaken for regurgitant as opposed to stenotic lesions, while long term survival is better in the context of degenerative as opposed to ischaemic or rheumatic valve pathologies. These observations illustrate the fact that long term mortality following valve replacement is most reflective of the nature of the original disease process, the pre- and postoperative state of the myocardium and coronary circulation, as well as the general wellbeing of the patient with valve related deaths being relatively infrequent. Approximately 60% of late mortality is attributable to cardiac causes that are independent of the valve surgery (namely, cardiac failure, myocardial infarction, arrhythmia or sudden death), approximately 20% is …