This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kalkat, M. S. Articles by Bonser, R. S. Search for Related Content PubMed PubMed Citation Articles by Kalkat, M. S. Articles by Bonser, R. S. Related Collections CV surgery: aortic and vascular disease CV surgery: valvular disease

(Circulation. 2007;116:I-301 – I-306.)
© 2007 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Composite Aortic Valve Graft Replacement

Mortality Outcomes in a National Registry

Maninder S. Kalkat, FRCS (CTh); Maria-Benedicta Edwards, MPhil; Keith M. Taylor, MD, FRCS; Robert S. Bonser, MD, FRCP, FRCS

From the United Kingdom Heart Valve Registry (M.-B.E., K.M.T.), the Department of Cardiothoracic Surgery (M.S.K., R.S.B.), University Hospital Birmingham NHS Trust and University of Birmingham (R.S.B.), UK.

Correspondence to Prof Robert S. Bonser, Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Edgbaston, Birmingham-B15 2TH, UK. E-mail robert.bonser{at}uhb.nhs.uk

Background— Composite aortic valve and root replacement (CVG) is a complex surgical procedure, but excellent center-specific outcomes are reported. We sought to report outcomes in a national cohort.

Methods and Results— The United Kingdom Heart Valve Registry was interrogated for 1962 first-time CVG (and 37 102 aortic valve replacements [AVR] as a reference group) procedures from 1986 to 2004. We analyzed 30-day mortality, long-term survival (97.2% complete follow-up), and examined available risk factors for mortality using univariate and multivariate logistic regression analysis and causes of death. CVG patients were younger, received larger valve sizes and were more likely to be emergent than AVR patients. Overall 30-day mortality was 10.7% (CVG) and 3.6% (AVR). For CVG, multivariate analysis identified advanced age (>70 years), concomitant coronary artery surgery, impaired left ventricular function, urgent or emergency status, prosthetic valve size 23 mm and hospital activity volume 8 procedures per annum as significant factors for 30-day mortality. Kaplan-Meier, 1-year, 5-year, 10-year and 20-year survival were 85.2%, 77.1%, 70% and 59.3%, respectively. The conditional (post–30-day) survival was similar to the AVR cohort.

Conclusions— These Registry data provide a unique national insight into CVG outcomes. After a higher initial mortality risk, CVG has equivalent conditional longer-term survival to AVR.

Key Words: follow up studies • aorta • aneurysm • valves