1Your Heart & Valves

6Prognosis after Valve Replacement Surgery

AVR should be considered palliative because the valve prosthesis introduces the patient to a new disease process in which complications include thromboembolism, anticoagulant-related bleeding, infection, and structural deterioration. Significant refinements in valve prostheses have reduced but not eliminated these problems. Furthermore, improvements in surgical technique and myocardial preservation continue to decrease the risks.
AVR is generally performed with low hospital mortality and complication rates, and significant symptomatic improvement can be expected. Aortic valve recipients have a favourable prognostic outcome.
Risk factors that determine long-term survival can be identified pre-operatively;
Bicuspid Aortic Valve Vs. Tricuspid, exercise capacity, peak heart rate, peak systolic blood pressure and peak early diastolic velocity (reflecting both systolic and diastolic function) are all better in survivors than in non-survivors. Non-survivors have considerably larger hearts.

Post operatively, small increases in exercise capacity are expected and ejection fraction increases among survivors. No such changes are seen in non-survivors.

A
fter valve replacement The Post Operative survivals are:
Long-Term Survival Factors for Bicuspid Aortic Valve:

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  “Patient self calculated Euro Score” 4.63%. (Surgery mortality).
  
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  Atrial fibrillation
  
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  Aortic Insufficiency (AI, Regurgitation) Mod/Severe
  
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  Ejection Fraction (EF force of muscle) 53% Normal
  
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  BAV - Dissection of the Ascending Aorta
  
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  Blood pressure at the first postoperative visit.
  

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  Post Operative survival 98+/-2%, valve related complications include thromboembolism, bleeding, deterioration of the prosthetic valve requiring re-operation and infective endocarditisis 1% per year.
  
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  In-hospital survivability (first 6 – 10 days) was 94-98%.
  
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  Major complication 21.7% of patients have one or more.
  

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  One month survival including the operative survivability is approximately 92 to 95%,
  
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  One year survival was 90-93%,
  
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  5 year survival, see graph above.
  

The prognosis for postoperative valve-related events; life expectancy and event-free life expectancy were 22 and 16 years in males aged 35 years respectively,
The presence of a bicuspid aortic valve increases the risk of postoperative dissection nine fold and occurs in patients with BAV at about 54 Vs 62 years in TAV. In a study of Aortic complications, dissection of the ascending aorta in patients with BAV replacements always occurred within 10 to 14 years of initial surgery and was usually fatal.

Actuarially Determined Complication Rates of Mechanical Valves for all patient types, % March 2000:

	Aortic			Mitral
	10 y	20 y	30 y	10 y	20 y	30 y
Mortality	25-55	40-78	52-100	25-55	40-77	52-100
Thrombo embolism	26	41	47	39	52	54
Bleeding	13	24	26	15	25	26
Endocarditis	4	7	11	4	7	9
Reoperation (explant)	10	15	19	9	21	24

6.1Papworth Scores

The dot is actual death rate. The horizontal line shows the 95% confidence interval around the actual death rate. The cross shows the predicted death rate for patients.

This 1st chart shows that Papworth has performed better than predicted in all cardiac surgery, coronary artery bypass grafting and valve surgery.

Cardiac Mortality by procedure 1st April 2004 - 31st March 2005

The 2nd chart shows no single surgeon in Papworth performs less well than that predicted by EuroSCORE.

All Cardiac Surgery by Surgeon 1st April 2004– 31st March 2005

7Recovery after heart surgery

7.1Care of your incision

You will be told how to care for your incision(s) before you leave the hospital. It is important to:

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  Keep your incision(s) clean and dry.
  
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  Use only soap and water to cleanse the area.
  

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  Bathing:
  
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    When showers and baths are permitted, they should be limited to 10 minutes. The water temperature should be warm - not too hot or cold. Extreme water temperatures can cause faintness.
    
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  Do not apply ointments, oils, salves or dressings to your incision unless specifically told to do so.
  
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  Eat a healthy diet to help healing.
  
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  Call your doctor if signs of infection appear:
  
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    Increased drainage or oozing from incision Increased opening of the incision line
    
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    Redness or warmth around the incision
    
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    Increased opening of the incision line
    
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    Increased body temperature (greater than 101 degrees Fahrenheit or 38 degrees Celsius)