Clinical Outcomes and Definitions
We reviewed all relevant clinical outcomes including all-cause
mortality, aortic valve reoperation, recurrent endocarditis, and New
York Heart Association (NYHA) functional class. Operative mortality was
defined as any death within 30 days, or at any time during the same
hospital stay. Postoperative morbidity was defined as major adverse
cardiac and cerebral events (stroke or myocardial infarction),
respiratory failure (prolonged mechanical ventilation >48
hours, tracheostomy, or need for reintubation), acute renal failure
requiring renal replacement therapy, and requirement of new permanent
pacemaker. Long-term clinical outcome data including NYHA functional
class, recurrence and reoperations were obtained for all patients by
personal contacts via phone interviews and office visits.
Residents/fellows and junior attending surgeons were considered as a
primary surgeon only when they performed all or most of the key portions
of the operation. Mean follow-up was 2.2 years (range: 0.1 to 9.1
years).