Các nguyên nhân của bệnh van động mạch chủ là phổ biến nhất từ sự thoái hóa vôi hoá nghiêm trọng như mô tả trước đây. Vì vậy đa số bệnh nhân có hẹp động mạch chủ như các bệnh lý cơ bản của van động mạch chủ. | 78 Chapter 5 any patient requiring valve replacement surgery with ESRD. Some have advocated a more individualized approach to choosing between a tissue and mechanical valve based on associated risk factors and that individual patient s expected long-term survival 22 . Aortic valve replacement The etiology of aortic valve disease is most commonly from severe calcific degeneration as previously described. Therefore the majority of patients have aortic stenosis as the underlying pathology of the aortic valve. However aortic insufficiency may be seen since endocarditis is the surgical indication for approximately 20 of patients requiring aortic valve replacement 14 15 17 . Coronary artery disease is frequently present and may require concomitant coronary revascularization. This is important as those patients requiring coronary revascularization in addition to aortic valve replacement have a decreased long-term survival compared to those patients having aortic valve replacement only. Evaluating the morbidity and mortality of aortic valve replacement is complicated by the fact that most centers report on different time intervals and frequently give an aggregate mortality of valvular replacement with ESRD. Thus many reports on mortality are actually a combination of patients with either aortic mitral or double valve replacement surgeries. Table 1 demonstrates the difficulty in making general conclusions about the overall outcome for replacement of the aortic valve. As can be seen Table 1 Aortic valve replacement. Survival Author Yr Pts Op Mort 1 yr 3 yr 5 yr Lucke 1997 12 16 60 42 Smedira 2000 27 0 36 27 50t 33t Craver 2002 55 3 61 29 16 Jamieson 2006 40 29 5 22 52t Survival for patients with bioprosthetic valves. tSurvival for patients with mechanical valves. Although the operative mortality was reported as 3 the 3 month mortality was 27 . The 16 survival was at 6 years. The early mortality was less for patients receiving mechanical valves vs with an overall .
