二尖瓣成形术治疗中重度黏液样退行性二尖瓣关闭不全远期疗效的影响因素

目的 探讨并总结二尖瓣成形术治疗中、重度黏液样退行性二尖瓣关闭不全远期疗效的影响因素.方法 分析1993年1月至2008年1月261例因中、重度黏液样退行性二尖瓣关闭不全行二尖瓣成形术的患者临床资料和随访资料.结果 围术期死亡7例,生存254例,生存患者二尖瓣成形效果良好.230例随访≥36个月,平均(77.3±30.3)个月,随访率90.6％；24例失访.多因素Cox regression分析显示,年龄≥60岁、左心室射血分数＜0.50、同期行冠状动脉旁路移植术是术后远期死亡的独立危险因素；左心室射血分数＜0.50、心功能(NYHA)Ⅲ-Ⅳ级、前瓣叶脱垂是术后远期二尖瓣再次中、重度反流的独立危险因素,成形环或塑形带成形是术后远期二尖瓣再次中、重度反流的保护因素.结论 年龄≥60岁、左心室射血分数＜0.50、同期行冠状动脉旁路移植术、心功能分级Ⅲ-Ⅳ级、前瓣叶脱垂、成形环或塑形带成形等因素与中、重度黏液样退行性二尖瓣关闭不全患者二尖瓣成形术后远期不良事件密切相关.     

非体外循环冠状动脉旁路移植术患者术中急性心功能失代偿的危险因素

目的 筛选非体外循环冠状动脉旁路移植术(OPCABG)患者术中发生急性心功能失代偿的危险因素.方法 选择本院2007年11月至2009年2月行OPCABG的患者2379例,记录术前、术中与急性心功能失代偿可能有关的因素.根据是否发生急性心功能失代偿,分为2组:急性心功能失代偿组和非急性心功能失代偿组.采用1ogistic多元回归分析,筛选发生急性心功能失代偿的危险因素.结果 术中发生急性心功能失代偿368例(发生率15.5%),无一例患者死亡.logistic多元回归分析显示,室壁瘤、术中房颤、术中频发性室性期前收缩、术前射血分数＜40%、术前室性期前收缩、合并瓣膜病、心肌梗死史、入室心动过速、急诊手术、左主干病变为术中发生急性心功能失代偿的危险因素.结论 术前合并室壁瘤、瓣膜病变、左主干病变、心肌梗死史、术前室性期前收缩、射血分数＜40%,术中房颤、频发性室性期前收缩、入室心动过速和急诊手术为OPCABG患者术中发生急性心功能失代偿的危险因素.     

心瓣膜置换术同期行冠状动脉旁路移植术患者长期预后的危险因素探讨

目的 探讨影响心瓣膜置换术同期行冠状动脉旁路移植术(CABG)患者长期预后的危险因素.方法 57例同期行心脏瓣膜置换术和冠状动脉旁路移植术的患者,同行CABG和主动脉手术13例,同行CABG和双瓣膜手术16例,同行CABG和二尖瓣手术28例;移植血管(1.97±1.36)支.通过随访获取数据,对潜在危险因素先用Cox比例风险模型进行单变量分析,再将有统计学意义(P＜0.05)的危险因素纳入Cox多变量回归.结果 失访2例,随访55例,平均随访时间(57.37±13.98)个月,随访期间共7例死亡;高龄(年龄＞70岁)、术前合并糖尿病、有心肌梗死史、慢性肺疾病和左心室射血分数≤40％为影响心瓣膜置换术和CABG同行患者长期预后的独立危险因素.结论 高龄、术前合并糖尿病、有心肌梗死史、有慢性肺疾病和左心室射血分数过低(≤40％)是影响两类手术同行患者长期预后的危险因素.     

非体外循环冠状动脉旁路移植术患者围术期血浆血管加压素和血管紧张素Ⅱ的变化及其对转归的影响

目的 探讨非体外循环(CPB)冠状动脉旁路移植术患者围术期血浆血管加压素(VP)和血管紧张素Ⅱ( Ang Ⅱ)的变化及其对转归的影响.方法 择期行非CPB冠状动脉旁路移植术患者50例,性别不限,年龄45～79岁,ASA分级和心功能NYHA分级Ⅰ-Ⅲ级.分别于麻醉诱导前(T1,基础状态)、切皮前(T2)、切皮后10 min(T3)、30 min(T4)、给予鱼精蛋白后10 min(T5)、术毕(T6)、术后24h(T7)时采集动脉血样,测定血浆VP及AngⅡ的浓度.记录患者围术期临床资料.根据术中血浆VP浓度的不同,采用系统聚类分析方法将患者分为高值组(n=26)和低值组(n=24).采用logistic回归分析筛选低血VP浓度的危险因素.结果与高值组比较,低值组T2～T6时血浆VP浓度降低,血浆Ang Ⅱ浓度升高,术中血管麻痹发生率升高,术中及术后扩血管药物使用率降低,气管导管拔除时间、ICU停留时间和术后住院时间延长,术前左室射血分数(LVEF)降低(P＜0.05或0.01).logistic回归分析结果表明,术前低LVEF是术中低血VP浓度的危险因素,比值比为1.122(P＜0.01).结论 非CPB冠状动脉旁路移植术患者术中血VP和Ang Ⅱ浓度变化趋势相反;低血VP浓度患者术中血管麻痹发生率升高,术后转归较差;术前低LVEF是术中低血VP浓度的危险因素.     

冠状动脉旁路移植术后急性肾损伤的危险因素临床分析

目的 探讨冠状动脉旁路移植术后急性肾损伤(AKI)的危险因素;明确体外循环是否是冠状动脉旁路移植术后独立危险因素.方法 根据AKI诊断标准:选择2010年9月-2013年11月在南京市第一医院行冠状动脉旁路移植术的患者209例,分为AKI组55例和非AKI组154例,通过单因素及多因素分析比较两组间可能的相关危险因素.结果 单因素分析中,AKI组中的性别(女性)、年龄、体重指数、高血压、基础血肌酐水平、心脏射血分数、冠状动脉粥样硬化数目、体外循环、主动脉球囊反博的循环支持、术后的低心排血量、乳酸水平均比非AKI组高(P＜0.05).多因素分析中,AKI组与非AKI组相比,基础血肌酐水平、心脏射血分数、体外循环、术后的低心排血量差异具有统计学意义(P＜0.05).结论 围术期的多种因素与冠状动脉旁路移植术后AKI的发生密切相关,基础血肌酐水平、心脏射血分数、体外循环、术后的低心排血量是冠状动脉旁路移植术后独立危险因素,采用非体外循环下行冠状动脉旁路移植术,有利于肾脏保护.     

二尖瓣成形术对轻中度缺血性二尖瓣关闭不全中期疗效的影响

目的评价单纯冠状动脉旁路移植术和同期加二尖瓣成形术对轻中度缺血性二尖瓣关闭不全（IMR）中期疗效的影响。方法1999年8月至2004年8月手术后生存的术前轻中度IMR病人60例，其中冠状动脉旁路移植术同期二尖瓣成形术（MVP组）和单纯冠状动脉旁路移植术（C组）各30例，分析术前资料，包括年龄、性别、二尖瓣反流程度、心功能、左心形态及左心室射血分数（LVEF）等，利用超声心动比较术后中期心功能和左心形态改善情况，利用生活质量评估表（SAQ量表）评价两组生活质量的改变。结果中期生存率MVP组为96．7％，C组为92．6％，两组差异无统计学意义。MVP组术后左心房内径缩小，C组左心房内径增大（P〈0．05），左心室内径改变两组差异无统计学意义。两组病人LVEF较术前均改善，但MVP组明显优于C组（P〈0．05）。MVP组术后生活质量明显优于C组病人，SAQ总得分分别为66．18和58．20（P〈0．05）。结论冠状动脉旁路移植术同期二尖瓣成形术可以明显提高轻中度IMR病人中期预后、生存率和生活质量，中期疗效优于单纯冠状动脉旁路移植术；     

左心室室功能不全类冠心病行冠状动脉旁路移植术预后分析

目的 分析左心室室功能不全类冠心病行冠状动脉旁路移植术预后.方法 2000年11月- 2010年12月,新疆自治区人民医院128例左心室射血分数≤35％的冠心病患者在非体外循环或体外循环下行单纯冠状动脉旁路移植术.结合术前左心室射血分数,分析术后早期并发症、病死率、左心室射血分数等相关结果.结果 术后早期左心室射血分数、左心室舒张末径均显著改善(P＜0.05),使用主动脉球囊反搏泵能够降低术后早期病死率,术后呼吸道感染、肾功能不全为主要并发症.结论 术前严重左心室功能不全与术后早期死亡原因无关,术前药物调整心功能,严格控制血压、血糖、心率平稳,术后积极使用主动脉球囊反搏是降低早期病死率的关键.     

影响冠状动脉旁路移植术手术死亡的危险因素分析

目的探讨影响我国冠状动脉旁路移植术(coronary artery bypass grafting,CABG)手术死亡的危险因素。方法选择北京阜外心血管病医院2002年1月1日至2003年12月31日(以手术日期为准)行CABG的冠心病患者2251例,确定潜在危险因素后,根据潜在危险因素从其临床资料中收集数据,对影响手术死亡的潜在危险因素进行单因素分析和logistic多因素回归分析,最终确立影响我国CABG手术死亡的危险因素,并对分析结果的校准度和分辨能力进行检验。结果全组手术死亡率为1.87%(42/2251),手术时年龄60.3±9.3岁,女性436例(19.4%)。logistic多因素回归分析结果:心源性休克、心律失常、左主干病变>50%、左心室射血分数(LVEF)、二尖瓣反流、肺动脉瓣反流、术前最后一次肌酐值、手术状态(非择期手术)、合并主动脉瘤手术等9个因素是本组CABG手术死亡的独立危险因素。受试者工作特征(Receiver-Operating Characteristic,ROC)曲线检验结果:曲线下面积为0.842。结论通过logistic多因素回归分析得出,心源性休克、心律失常、左主干病变>50%、LVEF、二尖瓣反流、肺动脉瓣反流、术前最后一次肌酐值、手术状态(非择期手术)、合并主动脉瘤手术等9个影响我国患者CABG手术死亡的危险因素。分析结果具有良好的校准度和分辨能力。     

非体外循环下冠状动脉旁路移植术后急性肾损伤危险因素分析

目的 分析出非体外循环下行冠状动脉旁路移植术后早期发生急性肾损伤的单因素和多因素危险因子.方法 分析2011年1月-2013年12月在非体外循环下行冠状动脉旁路移植术261例患者的临床资料,根据临床诊断AKI的标准,术后发生急性肾损伤的患者29例(AKI组),男22例,女7例,平均年龄(68.74±10.27)岁;未发生急性肾损伤的患者232例(非AKI组),男179例,女53例,平均年龄(66.26±9.82)岁.总结术前血压、左心室射血分数(LVEF)、左心室内径、血肌酐及术后并发症等,利用SPSS统计软件对急性肾损伤有关的因素进行Logistic回归分析.结果 全组AKI发病率为11.11％(29/261),住院死亡1例.统计学分析结果显示,术前血肌酐含量、麻醉时间、围术期输血是导致冠状动脉旁路移植术后发生AKI的危险因素.结论 AKI是冠状动脉旁路移植术后常见的并发症,术前应认真评估危险因素,加强肾功能保护才能降低AKI发生的风险.     

冠心病合并左室室壁瘤行冠状动脉旁路移植术未同期行左心室成形术的疗效分析

目的 分析冠心病合并左室室壁瘤形成患者仅行冠状动脉旁路移植术（CABG）但未同期行左心室成形术的疗效。 方法 2008年1月至2012年12月武汉亚洲心脏病医院收治冠心病合并室壁瘤患者共105例,术中探查发现室壁瘤边界欠清或活动欠佳或无明显矛盾运动而未处理室壁瘤患者共74例,其中男59例,女15例;年龄 （60.96±9.09） 岁。冠状动脉造影显示：单支血管病变5例,双支病变10例,3支病变45例,左主干＋3支病变14例。术中发现30例室壁瘤界限不清,29例心尖室壁变薄、室壁瘤不明显,15例室壁瘤未见明显的矛盾运动、心尖部质地较厚。所有患者均行冠状动脉旁路移植术。在体外循环下手术62例,非体外循环下手术12例。70例采用左乳内动脉吻合于左前降支,2例行左前降支内膜剥脱术。因二尖瓣中-重度反流行二尖瓣成形术3例,二尖瓣置换术2例;因合并主动脉瓣重度狭窄同期行主动脉瓣置换术1例。 结果 术后因恶性心律失常、缺血、缺氧性脑病死亡2例 （2.7%）;因低心排血量、围术期心肌梗死、恶性心律失常等行主动脉内球囊反搏 （IABP） 辅助6例。术后随访70例,随访时间24～60 （43±12） 个月。随访期间发现心室内血栓形成8例,其中5例服用华法林1年内血栓消失,无1例发生血栓脱落栓塞事件。超声心动图检查提示：室壁瘤消失18例 （25.7%）。出院时、术后6个月、1年射血分数较术前明显增高 （术后6个月与术前比较：44%±6% vs. 39%±5%）,左心室舒张期末内径 ［术后6个月与术前比较：（54.37±6.28） mm vs. （59.24±6.24）mm］、左心室收缩期末内径与术前比较明显缩小 （P＜0.01）。但随着时间延长,左心室舒张期末内径、左心室收缩期末内径较出院时逐渐增大。 结论 对于合并室壁瘤的冠心病患者,根据术中探查实际情况未行左心室成形术仅行冠状动脉旁路移植术,术后射血分数、左心室舒张期末内径、左心室收缩期末内径均较术前明显改善,但术后心室扩大呈进行性发展。     

主动脉瓣及二尖瓣直视成形手术

对２３例主动脉瓣及二尖瓣病变者行直视成形手术。引起瓣膜病变的原因：先天性病变５例，风湿性病变１８例。术前心功能，Ⅱ级者４例，Ⅲ级者１４例，Ⅳ级者５例。术后对２０例患者进行随访３～２４个月，心脏功能明显改善。     

二尖瓣置换术后远期功能性三尖瓣关闭不全的外科治疗

目的：报告二尖瓣置换（ＭＶＲ）术后远期三尖瓣关闭不全（ＴＲ）外科治疗的结果及作用,方法：３７例ＭＶＲ术后中重度ＩＲ病人,其中人工二尖瓣为生物瓣者１３,机械瓣２４例,有１１例行内科保守治疗,２６例行外科手术治疗,手术类型,ＭＶＲ加三尖瓣置换２例,ＭＶＲ加三法瓣成形１１例,三尖瓣置换３例,三尖瓣成型１０例,三尖瓣成形术包括改良Ｋay形成形１２例,改良ＤeVega成形术７例,加成形环的三尖瓣成形术２例,结果：１１例内科治疗者,７个月－７．５年后７６例死亡,病死率为５４．５％,26例手术治疗者,术后早期病死２例,病死率为７．７％,随访个月－１０．５年,晚期死亡例,仍中度ＴＲ２例,结论：ＭＶＲ术后远期ＴＲ的产生与不可逆的左心损害或（和）严重肺动脉高压有关,对重度ＴＲ伴有临床症状、左心功能基本正常者,行三尖瓣成形或三尖瓣置换术可取得良好的效果。     

Long-term experience with the Sorin Bicarbon and Edwards Mira mechanical valve prostheses in the mitral position

OBJECTIVE: Sorin Bicarbon (SB) and Edwards Mira (EM) valves have an identical mechanical design but different sewing cuffs. The purpose of this retrospective study was to analyze the long-term clinical and echocardiographic outcomes after mitral valve replacement with these two valves in a combined population of patients. METHODS: We retrospectively reviewed records of 73 patients who underwent mitral valve replacement using SB (n = 19) or EM (n = 54) valves. Preoperatively, 49 patients (68.1%) were in New York Heart Association (NYHA) functional class III or IV. Concomitant procedures were performed in 52 patients (71.2%). Early and late postoperative echocardiography was performed in 69 and 57 patients, respectively. RESULTS: Operative mortality was 4.1%, and early morbidity was 9.6%. Overall patient survival at 9 years was 85.1% +/- 4.8%. Actuarial freedom from valve-related death was 95.4% +/- 2.6% at 9 years. As shown by Doppler echocardiography, the early and late mean transprosthetic pressure gradients were 3.4 +/- 1.4 mmHg and 3.8 +/- 2.1 mmHg, respectively. At the end of follow-up, 98.4% of survivors were in NYHA class I or II. CONCLUSION: The Sorin Bicarbon and, Edwards Mira mechanical valves in the mitral position provide satisfactory long-term clinical and echocardiographic performance.     

有支架与无支架生物瓣膜行主动脉瓣置换临床对比研究

目的　探讨无支架Medtronic生物瓣行主动脉瓣置换的临床效果。方法　将 6 8例同期施行主动脉瓣置换术病人分为 2组 ,38例行无支架Medtronic生物瓣置换 ,30例对照组行有支架生物瓣置换。术前及术后 2个月随访行超声心动图检查。结果　无支架组和有支架组病人术后各项检测指标差异有显著性意义。无支架组跨瓣压差 (18 0± 3 7)mmHg(1mmHg =0 133kPa)明显低于有支架组(33 7± 8 3)mmHg;左室射血分数 0 6 5± 0 0 5 ,明显高于有支架组 0 5 6± 0 0 8;左室收缩末内径和左室舒张末内径分别为 (3 8± 0 8)cm和 (4 5± 0 4 )cm ,明显低于有支架组 (4 2± 1 4 )cm和 (5 1± 0 9)cm ;无支架组瓣环内径 (2 2 1± 1 8)mm大于有支架组 (19 5± 1 7)mm。结论　无支架Medtronic生物瓣较有支架生物瓣具有较低的跨瓣压差和良好的血流动力学 ,能促进左室功能的恢复。     

Comparative Rest and Exercise Hemodynamics of Allograft and Prosthetic Valves in the Aortic Position

Background. Allograft aortic valve replacement has gained widespread acceptance. However, there is little information about in vivo allograft valve function at rest and during exercise.

Methods. Cardiac catheterization was performed to measure hemodynamic variables at rest and during supine bicycle exercise in 44 patients who had had aortic valve replacement using allograft valves or Bicer or St. Jude Medical prosthetic valves 19 to 27 mm in diameter. Sixteen patients received an allograft valve; 17, a Bicer valve; and 11, a St. Jude Medical valve. There were no significant differences between the three groups in age, body surface area, left ventricular end-systolic and end-diastolic volume indices, exercise cardiac index, exercise heart rate, or work load achieved. Left ventricular and ascending aortic pressures were measured simultaneously according to the transseptal method.

Results. The mean pressure gradient was generally higher for the Bicer and St. Jude Medical valves than for the allograft valves, both at rest and during exercise. Significant differences were obtained in patients with small-sized valves (21 and 23 mm); pressure gradients were higher in the prosthetic valve groups. In patients with large-sized prosthetic valves (25 mm), there were no significant differences between the three groups at rest and during exercise. However, there was no pressure gradient at all for allograft valves.

Conclusions. Exercise cardiac catheterization confirms that the allograft aortic valve is an ideal substitute from the hemodynamic aspect, particularly in patients with a small aortic root and in those who perform strenuous exercise.     

小左室病人行二尖瓣置换术机械瓣膜型号的选择

目的探讨小左室病人行二尖瓣置换术时选择大口径机械瓣膜的可行性。方法将左室舒张末径小于40mm进行单独二尖瓣置换手术者分为小口径M-1二尖瓣25号瓣膜组和大口径M-2二尖瓣25号组。每组病人手术后均测定各瓣膜跨瓣压差、流速和肺动脉压，应用SPSS行统计分析。结果大口径M-2二尖瓣组和小口径M-1二尖瓣25号瓣膜组相比，跨瓣压差小[（5．9±1．6）mmHg对（10．7±3．2）mmHg]，在体瓣口面积大[（2．9±0．2）cm^2对（2．6±0．2）cm^2）]，瓣膜匹配指数大[（1．92±0．23）cm^2／m^2对（1．73±0．18）cm^2／m^2]，差异有统计学意义。结论在注意心肌保护和围术期处理的条件下，左室舒张末径较小者行二尖瓣置换手术时也应置入较大口径的机械二尖瓣瓣膜，以取得良好围术期血流动力学结果和临床效果。     

无支架二尖瓣制备、保存和体外三尖瓣置换技术探讨

目的观察深低温保存猪二尖瓣超微结构,探索无支架二尖瓣制作方法和置换三尖瓣技术。方法采用猪二尖瓣制成无支架瓣膜,抗生素灭菌深低温保存,透射电子显微镜观察深低温保存１个月的猪二尖瓣组织结构。将离体猪心三尖瓣切除,将无支架猪二尖瓣前瓣环缝合于隔瓣环,二尖瓣后瓣环缝合于三尖瓣前后瓣环,两乳头肌缝合于右心室前壁,完成无支架二尖瓣置换三尖瓣,注水试验观察瓣膜启闭功能。结果透射电子显微镜观察到,深低温保存猪二尖瓣内皮细胞结构完整,胶原纤维结构致密,排列整齐,成纤维细胞胞膜完整,细胞核无固缩现象,线粒体无明显肿胀。无支架二尖瓣置换的离体猪心三尖瓣启闭功能良好。结论深低温保存的无支架猪二尖瓣结构完整,活性得到很好保持。瓣膜设计合理,用此瓣膜置换三尖瓣技术可行     

Mitral Valve Replacement with Dura Mater Bioprostheses

Dura mater bioprostheses for cardiac valve replacement were first introduced in Brazil. They have been used since 1975 at the National Heart Hospital, London, as a mitral valve replacement instead of fascia lata valves or inverted aortic homograft valves. During this period 120 patients have had dura mater valves inserted in the mitral position; 29 also received an aortic valve replacement, 6 with dura mater, 20 with an aortic homograft, 2 with an aortic xeno-graft and 1 with a prosthetic valve. Perivalvular leaks occurred with seven of these mitral valves, and another seven presented with detached cusps. All but one of these 14 valves were replaced. Emboli have occurred in four of the patients, one of whom died after 35 months with thrombus on the aortic valve, but with an unaffected mitral valve. There were 15 early deaths, a hospital mortality of 12.5%. and 10 late deaths, a postoperative mortality of 9.5%. Actuarial analysis has shown a four-year postoperative survival of 78.970.     

Selection of Prosthetic Valve and Evidence—Need for the Development of Japan’s Own Guidelines

Purpose: In 2014, the American Heart Association (AHA)/American College of Cardiology (ACC) guidelines were largely revised with regard to the selection of prosthetic valves. (1) A mechanical prosthesis is reasonable for aortic valve replacement (AVR) or mitral valve replacement (MVR) in patients less than 60 years of age, (2) A bioprosthesis is reasonable in patients more than 70 years of age, and (3) Either a bioprosthetic or mechanical valve is reasonable in patients between 60 and 70 years of age.Japan faces the unprecedented population aging, and moreover, the average life expectancy is longer among the Japanese than the Westerners. In Japan, whether this choice is appropriate seems questionable.Methods: This time, with the revision of the AHA/ACC guidelines, it might be necessary to take into consideration the average life expectancy of Japanese people and revise the Japanese guidelines accordingly.Results: We should consider whether 60–70 years should be set as a gray zone regarding the age criteria for choosing biological valves, or if the age should be set higher relative to that specified in the western guidelines, given the longer Japanese life expectancy.Conclusion: We believe that the development of unique, Japanese guidelines for the selection of prosthetic valves will allow us to provide appropriate selection and treatment for each patient.     

THIRTY YEARS EXPERIENCE WITH HEART VALVE SURGERY: ISOLATED MITRAL VALVE REPLACEMENT

Background : Thirty years have elapsed since the commencement of open-heart surgery in South Australia. A retrospective study was performed to evaluate mortality and complication rates and to identify factors associated with poor outcomes in all patients who underwent prosthetic mitral valve replacement during this period. Methods : Questionnaires and personal contact have been used to generate a combined database of pre-operative and postoperative information and long-term follow-up on 938 patients who underwent isolated prosthetic mitral valve replacement at the Cardio-Thoracic Surgical Unit of the Royal Adelaide Hospital between 1963 and 1993. Results : Complete survival follow-up data were obtained for 92% (865) of the patients. The Starr-Edwards valve was used in 95% (891) of the patients, a Bjork-Shiley prosthesis in 2.5% (23) of the patients, and only 24 (2.5%) other valves were inserted. The hospital mortality rate for the 30-year period was 4.7%. The mean age of the patients who underwent surgery was greater in each of the three successive decades. A long-term survival advantage was observed for patients with mitral stenosis, however, survival was significantly shorter for patients with higher New York Heart Association (NYHA) functional classifications and for patients in pre-operative atrial fibrillation. Pre-operative dyspnoea was significantly improved following mitral valve replacement. The rates of postoperative haemorrhagic and embolic complications were low by comparison with other published series. Conclusion : Mitral valve recipients do not regain a normalized life expectancy, but risk factors that determine long-term survival can be identified pre-operatively to aid appropriate patient selection.