Original article: cardiovascularRepeated thromboembolic and bleeding events after mechanical aortic valve replacement
Section snippets
Patient selection
December 1963 was the start of the aortic valve replacement program at our institution and we studied the first 10 years of this program (December 1963 through January 1, 1974). A total of 312 patients underwent aortic valve replacement during this time. Reoperations, urgent, or combined procedures were included. Operative mortality before 1971 was 33% (44 of 132 patients) and from 1971 to 1974 it was 10.5% (19 of 180 patients). Causes of hospital death are mentioned in Table 1. Since none of
Late mortality
Overall actuarial survival among hospital survivors was 80.3% ± 2.6%, 57.4% ± 3.1%, and 33.6% ± 4.2% at postoperative years 10, 20, and 30, respectively (Fig 1). The linearized incidence rate was 3.2% ± 0.3% per year. Causes of death are shown in Table 3. Multivariate independent risk factors for death were age [hazard ratio increase of 1.0 per year (95% CI 1.0 to 1.1)], male gender [hazard ratio 1.7 (95% CI 1.1 to 2.7)], operation before 1970 [hazard ratio 1.6 (95% CI 1.1 to 2.4)], and
Overall TE and major BLE complications (global incidence)
In agreement with previous publications, the global incidence of TE or BLE complications was fairly high 4, 8, 9, 10, 11, 12. In this series, only 46.8% of the patients remained free from a first TE or BLE event at 30 years postoperatively. However, the linearized incidence rate for a first event in this series was 3% per patient–year, which compares favorably with reported incidence rates of 3% to 5% for the Starr-Edwards valve 4, 9, and an overall incidence of approximately 3.5% for the
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