The Annals of Thoracic Surgery, Vol 32, 111-119, Copyright © 1981 by The Society of Thoracic Surgeons
The ultimate prognosis after valve replacement: an assessment at twenty years
JF Teply, GL Grunkemeier, HD Sutherland, LE Lambert, VA Johnson and A Starr
Our experience over a 20-year period consists of 2,135 patients with
initial caged-ball valve replacement: 52% aortic, 34% mitral, 12% double,
and 2% triple-valve replacements, with 59.2, 39.8, 10.3, and 2.7
patient-centuries of follow-up, respectively. Fifteen-year actuarial
survival (+/- standard error) was 43 +/- 2% for aortic and 44 +/- 3% for
mitral valve replacement, and 27 +/- 5% for double-valve and 23 +/- 7% for
triple-valve replacement. Restricting attention to patients operated on
since 1973 divides the series almost in half and does not dramatically
improve the 5-year actuarial survival (from 66 +/- 2% to 71 +/- 3% and from
70 +/- 2% to 78 +/- 3% for aortic valve replacement and mitral valve
replacement, respectively). There was some alteration in the causes of late
death: the largest percentage of deaths in both the earlier and current
groups, 52%, was cardiac related whereas only 24% and 13%, respectively,
were valve related. Over the past two decades operative mortality has
declined and, to a lesser extent, late survival after mitral valve
replacement has improved. The incidence of embolism has decreased
significantly, most notably with the Silastic ball valves. Dramatic
improvements in late results will occur primarily by modifying the
cardiac-related death rate through earlier operation and improvements in
the medical management of postoperative arrhythmias and congestive heart
failure.
