Search tips
Search criteria 


Logo of thijTexas Heart Institute JournalSee also Cardiovascular Diseases Journal in PMCSubscribeSubmissionsTHI Journal Website
Tex Heart Inst J. 1987 June; 14(2): 144–153.
PMCID: PMC324714

Determinants of Long-term Survival after Isolated Aortic Valve Replacement: A 10- to 17-Year Follow-up

Ole Lund, M.D.


During a 9-year period from January 1965 through December 1973, we performed isolated aortic valve replacement (AVR) for aortic stenosis (AS) or aortic regurgitation (AR) in 165 patients. All operations were done during total cardiac arrest using chemical cardioplegia according to the method of Bretschneider. The prostheses used were predominantly Starr-Edwards caged ball valves. One hundred thirty-nine patients were alive 30 days after operation. The 5-, 10-, and 15-year cumulative survival rates (± SE) were 78 ± 4%, 62 ± 4%, and 29 ± 9%, respectively. In comparison to a sex- and age-matched control population, our patients had an excess mortality in the first postoperative year and again after the twelfth year. Patients who underwent AVR in 1972 and 1973 had better results than those who had operations in 1965 through 1971 (p < 0.05); the 1972-1973 patients had 5- and 10-year survival rates of 81 ± 5% and 72 ± 5%, respectively. The 1-year survival rate was 91% for patients with AS and 71% for those with AR (p < 0.05). In AS patients, long-term survival was adversely affected by a history of left ventricular failure, inclusion in NYHA functional class IV, cardiothoracic index of ≥ 0.56, cardiac index of < 3.0 L/min/m2, age > 55 years, previous myocardial infarction, systemic pulse pressure of ≤ 40 mm Hg, mean left atrial pressure of ≥ 15 mm Hg, and mean pulmonary artery pressure of ≥ 24 mm Hg. In AR patients, an adverse prognosis was associated with left ventricular failure, syncope, age ≥ 60 years, and NYHA class IV status. These results indicate that, in both AS and AR patients, operation should be performed early, before severely limiting symptoms and signs arise. (Texas Heart Institute Journal 1987; 14:144-153)

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.0M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Acar J, Luxereau P, Ducimetiere P, Cadilhac M, Jallut H, Vahanian A. Prognosis of surgically treated chronic aortic valve disease. Predictive indicators of early postoperative risk and long-term survival, based on 439 cases. J Thorac Cardiovasc Surg. 1981 Jul;82(1):114–126. [PubMed]
  • Macmanus Q, Grunkemeier GL, Lambert LE, Teply JF, Harlan BJ, Starr A. Year of operation as a risk factor in the late results of valve replacement. J Thorac Cardiovasc Surg. 1980 Dec;80(6):834–841. [PubMed]
  • Murphy DA, Levine FH, Buckley MJ, Swinski L, Daggett WM, Akins CW, Austen WG. Mechanical valves: a comparative analysis of the Starr-Edwards and Björk-Shiley prostheses. J Thorac Cardiovasc Surg. 1983 Nov;86(5):746–752. [PubMed]
  • Oyer PE, Stinson EB, Reitz BA, Miller DC, Rossiter SJ, Shumway NE. Long-term evaluation of the porcine xenograft bioprosthesis. J Thorac Cardiovasc Surg. 1979 Sep;78(3):343–350. [PubMed]
  • Hill AG. Concluding remarks. Proc R Soc Med. 1977;70(Suppl 3):146–146. [PMC free article] [PubMed]
  • Bretschneider HJ, Hübner G, Knoll D, Lohr B, Nordbeck H, Spieckermann PG. Myocardial resistance and tolerance to ischemia: physiological and biochemical basis. J Cardiovasc Surg (Torino) 1975 May-Jun;16(3):241–260. [PubMed]
  • Sondergaard T, Senn A. 109. Klinische Erfahrungen mit der Kardioplegie nach Bretschneider. Langenbecks Arch Chir. 1967;319:661–665. [PubMed]
  • Sondergaard T, Berg E, Staffeldt I, Szczepanski K. Cardioplegic cardiac arrest in aortic surgery. J Cardiovasc Surg (Torino) 1975 May-Jun;16(3):288–290. [PubMed]
  • Szczepanski KP, Albrechtsen O, Axelsen F, Sondergaard T. Primaere resultater efter indsaettelse af aortaklapprotese. Ugeskr Laeger. 1977 Jul 24;139(30):1775–1778. [PubMed]
  • Copeland JG, Griepp RB, Stinson EB, Shumway NE. Long-term follow-up after isolated aortic valve replacement. J Thorac Cardiovasc Surg. 1977 Dec;74(6):875–889. [PubMed]
  • Rubin JW, Moore HV, Hillson RF, Ellison RG. Thirteen year experience with aortic valve replacement. Am J Cardiol. 1977 Sep;40(3):345–354. [PubMed]
  • Copeland JG, Griepp RB, Stinson EB, Shumway NE. Long-term follow-up after isolated aortic valve replacement. J Thorac Cardiovasc Surg. 1977 Dec;74(6):875–889. [PubMed]
  • Teply JF, Grunkemeier GL, Sutherland HD, Lambert LE, Johnson VA, Starr A. The ultimate prognosis after valve replacement: an assessment at twenty years. Ann Thorac Surg. 1981 Aug;32(2):111–119. [PubMed]
  • Grunkemeier GL, Macmanus Q, Thomas DR, Luber JM, Lambert LE, Suen YF, Starr A. The use of time-interrelated covariates to predict survival following aortic valve replacement. Ann Thorac Surg. 1980 Sep;30(3):240–246. [PubMed]
  • Björk VO, Henze A. Ten years' experience with the Björk-Shiley tilting disc valve. J Thorac Cardiovasc Surg. 1979 Sep;78(3):331–342. [PubMed]
  • Magilligan DJ, Jr, Lewis JW, Jr, Tilley B, Peterson E. The porcine bioprosthetic valve. Twelve years later. J Thorac Cardiovasc Surg. 1985 Apr;89(4):499–507. [PubMed]
  • Martinell J, Fraile J, Artiz V, Moreno J, Rábago G. Long-term comparative analysis of the Björk-Shiley and Hancock valves implanted in 1975. J Thorac Cardiovasc Surg. 1985 Nov;90(5):741–749. [PubMed]
  • Black MM, Drury PJ, Tindale WB. Twenty-five years of heart valve substitutes: a review. J R Soc Med. 1983 Aug;76(8):667–680. [PMC free article] [PubMed]
  • Roberts DL, DeWeese JA, Mahoney EB, Yu PN. Long-term survival following aortic valve replacement. Am Heart J. 1976 Mar;91(3):311–317. [PubMed]
  • Barnhorst DA, Oxman HA, Connolly DC, Pluth JR, Danielson GK, Wallace RB, McGoon DC. Long-term follow-up of isolated replacement of the aortic or mitral valve with the Starr-Edwards prosthesis. Am J Cardiol. 1975 Feb;35(2):228–233. [PubMed]
  • Carabello BA, Green LH, Grossman W, Cohn LH, Koster JK, Collins JJ., Jr Hemodynamic determinants of prognosis of aortic valve replacement in critical aortic stenosis and advanced congestive heart failure. Circulation. 1980 Jul;62(1):42–48. [PubMed]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute