cAn Official Journalof the cAmericanHeartcAssociatio

Fivehundred consecutive patients underwent aortic valve replacement andcoronary revascularization inthe yearsfrom1967to1981, with29(5.9%) in-hospital deaths. Current operative mortality (1978-1981) is3.4%.Univariate andmultivariate analyses were usedtoidentify determi- nantsofearly andlate risk. Female sex,aortic insufficiency, andadvanced age increased in-hospital mortality, whereas use ofcardioplegia decreased it.Atfollow-up of471patients whosurvived hospitalization for 1 to135months (mean41)after surgery,96late deaths were documented. Survival rates were87%,80%,and55%,andevent-free survival rates were 80%,65%,and39%at2,5,and10 yearsafter surgery,respectively. Thelate survival rate was unfavorably influenced bythe presenceof moderately orseverely impaired left ventricular function anddouble-vessel coronarydisease; therate was enhanced forpatients inagegroupfrom50to59yearsoldandwas notinfluenced bythemethodof myocardial protection. Theevent-free survival ratedecreased withthepresenceofmoderately or severely impaired left ventricular function andwas enhanced forpatients withNew YorkHeart Association class Ior II symptomsbefore surgery.Patients withbioprostheses whodidnotreceive anticoagulants hadhigher survival'and event-free survival ratesthandideither patients withbiopros- theses whoreceived anticoagulants orpatients withmechanical valves, whether theyreceived anticoag- ulants ornot.