Table 3.
Association of patient characteristics with long-term survival after AVR at 1-20 years of age.
| Total | In-hospital survival after AVR | Long-term transplant-free survival after hospital discharge from AVR | |||||||
|---|---|---|---|---|---|---|---|---|---|
| N | N (%) | p-valuea | 1-year | 5-year | 10-year | 20-year | 25-year | p-valueb | |
| Total | 911 | 888 (97.5) | - | 96.7 | 95.3 | 91.8 | 85.0 | 80.1 | - |
| Valve type | |||||||||
| R-AVR | 416 | 411 (98.8) | 97.8 | 97.1 | 95.6 | 91.2 | 86.1 | ||
| M-AVR | 391 | 377 (96.4) | 0.07 | 94.7 | 92.6 | 88.3 | 80.7 | 75.9 | <0.001 |
| T-AVR | 104 | 100 (96.1) | 100.0 | 98.0 | 89.0 | 76.1 | 71.2 | ||
| Sex | |||||||||
| Male | 669 | 653 (97.6) | 0.67 | 96.5 | 95.0 | 91.9 | 84.5 | 79.8 | 0.73 |
| Female | 242 | 235 (97.1) | 97.5 | 96.2 | 91.5 | 86.4 | 81.0 | ||
| Age at AVR | |||||||||
| 1 – 5 years | 143 | 138 (96.5) | 97.8 | 94.9 | 93.5 | 87.0 | 82.0 | ||
| 6 – 10 years | 199 | 192 (96.5) | 0.27 | 97.4 | 96.4 | 92.2 | 85.8 | 81.8 | 0.90 |
| 11 - 20 years | 569 | 558 (98.1) | 96.2 | 95.0 | 91.2 | 84.5 | 80.0 | ||
| Era of AVR (~tertiles) | |||||||||
| 1982 - 1994 | 265 | 257 (97.0) | 97.3 | 95.7 | 92.6 | 84.4 | 80.9 | ||
| 1995 - 1998 | 348 | 336 (96.6) | 0.12 | 96.7 | 94.9 | 90.2 | 83.9 | - | 0.47 |
| 1999 - 2003 | 298 | 295 (99.0) | 96.3 | 95.3 | 92.9 | - | - | ||
| Pathophysiology at AVR | |||||||||
| Stenosis | 105 | 101 (96.2) | 98.0 | 95.1 | 89.1 | 83.7 | 82.5 | ||
| Regurgitation | 279 | 269 (96.4) | 0.18 | 95.5 | 94.1 | 89.6 | 80.4 | 75.6 | 0.03 |
| Both | 527 | 518 (98.3) | 97.1 | 96.0 | 93.4 | 87.7 | 81.8 | ||
| Other left heart obstruction c | |||||||||
| None | 669 | 661 (98.8) | 97.1 | 96.4 | 92.9 | 86.2 | 81.9 | ||
| Present at 1 level | 169 | 159 (94.1) | <0.01 | 95.0 | 91.8 | 89.3 | 82.4 | 76.2 | 0.22 |
| Present at 2 levels | 65 | 60 (92.3) | 96.7 | 93.3 | 88.3 | 80.0 | 69.8 | ||
| Present at 3 levels | 8 | 8 (100.0) | 100.0 | 87.5 | 75.0 | 75.0 | - | ||
| Genetic conditions d | |||||||||
| None | 843 | 824 (97.8) | 96.8 | 95.3 | 92.5 | 85.9 | 81.0 | - | |
| Down syndrome | 11 | 10 (90.9) | 0.23 | 100.0 | 100.0 | 90.0 | 90.0 | 90.0 | 0.53 |
| Other | 57 | 54 (94.7) | 0.16 | 94.4 | 94.4 | 81.5 | 71.1 | 64.6 | 0.002 |
| Concurrent procedure d | 123 | 116 (94.3) | 0.03 | 95.7 | 92.2 | 88.8 | 77.1 | 66.7 | 0.002 |
| Konno procedure | 103 | 96 (93.2) | 0.01 | 97.9 | 93.8 | 90.6 | 79.5 | 66.1 | 0.04 |
| Mitral valve repair | 24 | 23 (95.8) | 0.46 | 87.0 | 82.6 | 78.3 | 56.2 | 56.2 | <0.001 |
| Arch repair | 7 | 7 (100.0) | 1.00 | 100.0 | 100.0 | 100.0 | 100.0 | - | 0.28 |
| Pacemaker placemente | 44 | 42 (95.5) | 0.31 | 92.9 | 88.1 | 83.3 | 78.3 | 70.3 | 0.09 |
| None | 788 | 772 (98.0) | - | 96.9 | 95.7 | 92.2 | 86.2 | 81.8 | - |
| Prior cardiac interventions d | 528 | 506 (95.8) | <0.01 | 95.5 | 93.1 | 89.1 | 81.8 | 76.5 | 0.003 |
| Balloon valvuloplasty | 142 | 138 (97.2) | 0.77 | 97.8 | 97.1 | 94.9 | 89.6 | 87.9 | 0.09 |
| Aortic valve repair | 326 | 315 (96.6) | 0.22 | 96.5 | 94.9 | 91.1 | 84.1 | 80.0 | 0.99 |
| Aortic arch repair | 100 | 95 (95.0) | 0.10 | 95.8 | 90.5 | 87.4 | 80.6 | 72.2 | 0.22 |
| Pacemaker placement | 20 | 19 (95.0) | 0.40 | 84.2 | 79.0 | 79.0 | 62.4 | 50.0 | 0.002 |
| None | 383 | 382 (99.7) | - | 98.4 | 98.2 | 95.3 | 89.2 | 85.0 | - |
| Complex heart disease | |||||||||
| Yes | 82 | 79 (96.3) | 0.45 | 89.9 | 86.1 | 78.5 | 62.4 | 56.2 | <0.001 |
| No | 829 | 809 (97.6) | 97.4 | 96.2 | 93.1 | 87.2 | 82.4 | ||
| Case volume per 12 months | |||||||||
| Small (10-99) | 87 | 84 (96.6) | 97.6 | 96.4 | 95.2 | 84.5 | 79.9 | ||
| Medium (100-199) | 314 | 305 (97.1) | 0.70 | 97.1 | 95.7 | 90.8 | 83.0 | 77.8 | 0.75 |
| Large (≥ 200) | 422 | 413 (97.9) | 95.9 | 94.4 | 92.3 | 87.2 | 81.3 | ||
| % of high-risk cases | |||||||||
| < 9.4% | 377 | 369 (97.9) | 0.47 | 96.5 | 95.7 | 92.7 | 86.7 | 82.7 | 0.20 |
| ≥ 9.4% | 446 | 433 (97.1) | 96.5 | 94.7 | 91.5 | 84.2 | 76.4 | ||
| High risk postoperative mortality | |||||||||
| < 3.8% | 646 | 635 (98.3) | <0.01 | 97.0 | 95.6 | 93.2 | 87.1 | 81.9 | 0.01 |
| 177 | 167 (94.4) | 94.6 | 93.4 | 87.4 | 78.7 | 72.4 | |||
a
Chi-square or Fisher’s exact p-value when at least one expected cell count was less than 5 (left heart obstruction; Down’s syndrome; other genetic conditions; concurrent Konno, mitral valve repair, arch repair or pacemaker placement; prior balloon valvuloplasty, arch repair, or pacemaker placement; complex heart disease; and high-risk postoperative mortality)
b
log-rank p-value.
c
Left heart obstruction was considered as stenosis at the mitral valve, sub-aortic area, or aortic arch.
d
p-values for these characteristics are calculated separately for each group compared with the reference group of none.
e
During or up to 30 days after AVR procedure.