Long-term outcome of surgically treated XXXX : influence of guideline adherence toward early surgery.

@entity1 @entity712 @entity944 @entity337 @entity204
OBJECTIVES: The purpose of this study was to compare postoperative outcome in two groups of @entity1 with chronic severe @entity337 ( @entity337 ): those operated on early and those operated on late according to the guidelines. BACKGROUND: The impact of earlier surgery for chronic severe @entity337 as defined in guidelines has not been evaluated. METHODS: A total of 170 @entity1 with chronic severe @entity337 submitted to aortic valve replacement were prospectively followed up. @entity1 were divided in two groups depending on the clinical situation at the time of surgery. Group A were 60 @entity1 who were operated on following guidelines advice of earlier surgery, and group B were 110 @entity1 who were operated on late with regard to guideline recommendations. RESULTS: Follow-up was 10 +/- 6 years (1 to 22 years). During follow-up 44 @entity1 died, 7 @entity1 (12%) from group A and 37 (37%) from group B (p = 0.001). The cause of @entity204 was non-cardiac in 11 @entity1 , 2 (3%) in group A and 9 (8%) in group B. @entity204 occurred in 33 @entity1 , 5 (9%) from group A and 28 (28%) from group B (p = 0.002). Causes of @entity204 differed between groups A and B: @entity712 or @entity944 were significantly more frequent in group B (20 @entity1 vs. 1 @entity1 , p = 0.001). Overall survival in groups A and B was 90 +/- 4% vs. 75 +/- 8% at 5 years, 86 +/- 5% vs. 64 +/- 5% at 10 years, and 78 +/- 7% vs. 53 +/- 6% at 15 years, respectively (p = 0.009). CONCLUSIONS: Early operation as defined in the guidelines improves long-term survival in @entity1 with chronic @entity337 .
