Results of surgical treatment of valvular calcified aortic stenosis: a series of 4129 interventions

Aortic stenosis (AS) is the most common lesion currently encountered among valvular heart disease particularly in elderly people, Severe functionnal impairment and risk of sudden death explain that surgical treatment is largely accepted. We report a retrospective analysis of institutional experience with aortic valve replacement (A VRI for AS from 1971-1997 in 4 129 patients. Age ranged from 13 to 91 years (mean 68 +/- 10) and degenerative disease was largely predominant (86 %). For A VR, mechanical prostheses were used in 2 054 patients (50.2 %) mid bioprostheses in 2 075 (48.8 %) in elderly group, Coronary artery revascularization was associated in 670 patients (16 %). Operative mortality was 7 % (303 pts) and main cause was left ventricular failure (52 %). Late results were studied with a maximum follow-up of 26 years Total follow-up reprensents 21,533 pt-years. Late death occurred in I 108 patients between I month and 24 years after operation (mean 6,6 years), Reoperation was necessary in 136 cases Actuarial survival - including operative mortality - was 77 % and 56 % at 5 and 10 years. A large functionnal improvement was observed in the vast majority of patients, 73 % being I or II subgroups Of the NYHA classification. Incremental risk factors for death (immediate as,well as late) were alder age, preoperative functionnal status, emergency, presence of cardiac failure, coronary artery lesions and associated morbidity. The choice of valvular prosthesis remains controversial, but the results shaw that A VR is the procedure of choice for the vast majority of patients with significant aortic valve disease.