Abbreviations, Acronyms & Symbols
calcification, stroke, intra-cardiac mass, primary mitral regurgitation, rest ≤ 50%.-, aortic stenosis, acute myocardial infarction, thrombocytopenia, non-heart disease, mitral regurgitation, substance abuse, valve area ≤, mitral stenosis, leukopenia, anemia, aortic insufficiency, thrombus, end-stage renal disease, Valve regurgitation, pseudosevere aortic stenosis.- Symptomatic, hyperparathyroidism.- LVEF ≤
STROKE, THORACIC, DYSFUNCTION, AORTIC STENOSIS, HEART, ACUTE MYOCARDIAL INFARCTION, THROMBOCYTOPENIA, MITRAL REGURGITATION, EMERGENCY, DILATION, MITRAL STENOSIS, LEUKOPENIA, RENAL FAILURE, ANEMIA, AORTIC INSUFFICIENCY, THROMBUS, END-STAGE RENAL DISEASE, PULMONARY HYPERTENSION, FIBRILLATION, SYMPTOMATIC AORTIC STENOSIS, TRANSIENT ISCHEMIC ATTACK, HEMORRHAGIC DIATHESIS, SECONDARY, HYPERTENSION
Adverse eventsAcute myocardial infarctionAortic valve replacementBody mass indexBovine Pericardium Organic Valvular BioprosthesisCoronary artery bypass graftingChronic obstructive pulmonary diseaseElectrocardiogramElectronic Case Report FormsEffective orifice areaEuropean System for Cardiac Operative Risk EvaluationHeart failureInternational Organization for StandardizationLate patient-yearLeft ventricularLeft ventricular ejection fractionMajor adverse cardiovascular and cerebrovascular eventMitral valve replacementNew York Heart AssociationObjective performance criteriaPercutaneous coronary intervention


Patients who have already undergone aortic or mitral valve replacement and have
been followed up in the selected institutions for one year were included.
- Symptomatic patients with severe aortic insufficiency.- Asymptomatic patients with severe aortic insufficiency and with left
ventricular ejection fraction (LVEF) at rest ≤ 50%.- Patients with severe aortic insufficiency and undergoing coronary
artery bypass grafting (CABG) or surgery of the ascending aorta or other
valve.- Asymptomatic patients with severe aortic insufficiency and with resting
ejection fraction > 50% with severe left ventricular (LV) dilation:
LV end-diastolic diameter > 70 mm or LVEF > 50 mm (or LVEF > 25
mm/m2 of body surface, in patients with small body size).- Symptomatic patients with severe aortic stenosis of high gradient (mean
gradient ≥ 40 mmHg or peak speed ≥ 4.0 m/s).- Symptomatic patients with severe low flow low gradient (< 40 mmHg),
aortic stenosis with reduced ejection fraction, and evidence of flow
reserve (contractile) excluding pseudosevere aortic stenosis.- Symptomatic patients with low flow aortic stenosis and low gradient
(< 40 mmHg) with normal ejection fraction after careful confirmation
of severe aortic stenosis.- Symptomatic patients with low flow and low gradient aortic stenosis and
reduced ejection fraction without flow reserve (contractile),
particularly when the amount of calcium on computed tomography confirms
severe aortic stenosis.- Patients with symptomatic aortic stenosis with low surgical risk
(Society of Thoracic Surgeons or European System for Cardiac Operative
Risk Evaluation [EuroSCORE] II < 4% or EuroSCORE I logistical <
10% and no other risk factors not included in these scores, such as
frailty, porcelain aorta, chest radiation sequelae).- Asymptomatic patients with severe aortic stenosis and LV systolic
dysfunction (LVEF < 50%) not due to another cause.- Asymptomatic patients with severe aortic stenosis and an abnormal
exercise test showing exercise symptoms clearly related to aortic
stenosis.- Asymptomatic patients with severe aortic stenosis and an abnormal
exercise test showing a decrease in blood pressure below the
baseline.- Asymptomatic patients with normal ejection fraction and no abnormality
of the exercise test, if the surgical risk is low and there is very
severe aortic stenosis defined by a peak transvalvular velocity (Vmax)
> 5.5 m/s.- Asymptomatic patients with normal ejection fraction and no abnormality
of the exercise test, if the surgical risk is low and severe valve
calcification and Vmax progression rate ≥ 0.3 m/s/year.- Asymptomatic patients with normal ejection fraction and no abnormality
of the exercise test, if the surgical risk is low and there are high
levels of type B natriuretic peptide markers.- Asymptomatic patients with normal ejection fraction and no changes in
exercise test, if the surgical risk is low and there is severe pulmonary
hypertension (systolic arterial pressure of the resting pulmonary artery
> 60 mmHg confirmed by invasive measure) without further
explanation.- Patients with severe aortic stenosis undergoing CABG or surgery of the
ascending aorta or another valve.- Patients with moderate aortic stenosis undergoing CABG or surgery of
the ascending aorta or another valve after decision of the Heart
Team.
- Symptomatic patients with severe primary mitral regurgitation and LVEF
> 30%.- Asymptomatic patients with severe primary mitral regurgitation and LV
dysfunction (LVEF > 45 mm and/or LVEF < 60%).- Asymptomatic patients with severe primary mitral regurgitation and
preserved LV function (LVEF < 45 mm and LVEF > 60%) and atrial
fibrillation secondary to mitral regurgitation or pulmonary hypertension
(resting systolic pulmonary pressure > 50 mmHg).- Asymptomatic patients with severe primary mitral regurgitation and
preserved LVEF (> 60%) and LVEF 40-44 mm, with leaflet failure.- Asymptomatic patients with severe primary mitral regurgitation and
preserved LVEF (> 60%) and LVEF 40-44 mm, and presence of significant
left atrial dilation (volume index ≥ 60 mL/m- Patients with severe primary mitral regurgitation and severe LV
dysfunction (LVEF < 30% and/or LVEF > 55 mm) refractory to medical
therapy.- Patients with severe secondary chronic mitral regurgitation undergoing
CABG and LVEF > 30%.- Symptomatic patients with severe secondary mitral regurgitation, LVEF
< 30%, but with the option for revascularization and evidence of
myocardial viability.- Patients with severe secondary mitral regurgitation and LVEF > 30%
who remain symptomatic despite the ideal clinical treatment and with low
surgical risk.- Symptomatic patients with mitral stenosis (valve area ≤ 1.5
cm
- Emergency surgical valve replacement.- Aortic root surgical replacement.- Patients who did not return for follow-up exams.- Patients with renal failure, as determined by creatinine level ≥
2.5 mg/dL or end-stage renal disease that requires chronic dialysis.- Patients with stroke or transient ischemic attack within six months
(180 days) before planned valve surgery.- Patients with acute myocardial infarction within 30 days before planned
valve surgery.- Patients with any known life-threatening non-heart disease that will
limit their life expectancy below one year.- Patients diagnosed with abnormal calcium metabolism and
hyperparathyroidism.- LVEF ≤ 20%, as validated by diagnostic procedure before planned
valve surgery.- Echocardiographic evidence of intra-cardiac mass, thrombus, or
vegetation.- Hemodynamic or respiratory instability that requires inotropic support,
mechanical circulatory support, or mechanical ventilation within 30 days
before planned valve surgery.- Documented leukopenia (leukocytes < 3.5×10³/µL), acute
anemia (Hgb < 10.0 gm/dL or 6 mmol/L), or thrombocytopenia (platelet
count < 50×10³/µL) accompanied by a history of
hemorrhagic diathesis and coagulopathy.- Patients who underwent organ transplantation.- Pregnant or breastfeeding patients.- Patients with a documented history of substance abuse (drugs or
alcohol) in the last year before implantation.- Concomitant positioning of the LV assist device.
Distribution of valve sizes implanted in the aortic position.
Distribution of valve sizes implanted in the mitral position.Causes of 30-day mortality.AVR=aortic valve replacement; MVR=mitral valve replacement
Change in New York Heart Association classification from
baseline.
Valve regurgitation in 1-year follow-up.