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Outcomes after Aortic Valve Replacement: Mechanical vs Bioprosthetic Valves in Patients 50-70 Years
Session:
Sessão de Comunicações Orais - Doença Valvular
Speaker:
Rafael Gonçalves da Rocha
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.6 Valvular Heart Disease – Clinical
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rafael Gonçalves da Rocha; Rui Cerqueira; Francisca Saraiva; Soraia Moreira; Jorge Almeida; Mário Jorge Amorim; Paulo Pinho; André Lourenço; Adelino Leite-Moreira
Abstract
<p> <strong>Introduction</strong>: The choice of the best prosthetic valve for each patient is a recurring and controversial question in cardiac surgery, especially in the 50-70 year old age-group, in which European and American guidelines differ.</p> <p> <strong>Objectives</strong>: To compare 7-year survival and freedom from reoperation, as well as early clinical and haemodynamic outcomes, after surgical aortic valve replacement (SAVR) with mechanical or bioprosthetic valves in patients aged 50-70 years.</p> <p> <strong>Methods</strong>: We performed a single-center retrospective cohort study including all adults aged 50-70 years who underwent SAVR in 2012 with a mechanical or Freedom Solo®, Trifecta® or Perimount® bioprosthetic valves. Pre-, Peri- and Post-operative data, including EuroScoreII, follow-up echocardiogram performed at 3 (2-5) months and need of reoperation were obtained from patient and national records. Median follow-up was 7 years. Univariable analyses were performed using Kaplan-Meier curves and Log-Rank tests for survival and freedom from reoperation analyses. A Logistic Regression and a Cox Regression, both adjusted for EuroScoreII, were done to estimate the effect of prosthesis type on hospital mortality and late mortality, respectively.</p> <p> <strong>Results</strong>: Of a total of 193 patients, 76 (39.4%) received mechanical valves and 117 (60.6%) received bioprosthetic valves. The former were significantly younger (59.5 [62-68] vs 66 years [55-63], p<0.001), and had a higher prevalence of Atrial Fibrillation (AF) (32% vs 13.8%), p=0,003). Furthermore, they were more likely to undergo concurrent interventions on other valves (31,6% vs 12%, p=0.001), but less likely to undergo simultaneous CABG (19,7% vs 33,3%, p=0.04). The median EuroScoreII was higher in the mechanical group (2.52% vs 1.95%, p=0.06), as was early mortality (2.6% vs 7.9%). After adjusting for EuroScoreII, we did not find a significant difference in early mortality (OR=2,32 [0,515-10,496], p=0.272) or in 7-year survival (HR=0,427 [0,157-1,162], p=0.096). Freedom from reoperation at 7 years was higher in the mechanical group (100% vs 95,5%, Log-Rank=0.076). Regarding haemodynamic performance at follow-up echocardiogram, there were no differences in mean transprosthesis gradient (14,15mmHg in the Mechanical group vs 13 mmHg in the Bioprosthesis group, p=0.115) or severe Patient-Prosthesis Mismatch (4,6% vs 5,1%, p=0.888). However, reverse remodelling was not as pronounced (-14% vs -21%, p=0,036).</p> <p> <strong>Conclusion</strong>: Mechanical and bioprosthetic aortic valves prostheses were comparable in terms of mid-term survival and early haemodynamic performance, in the 50-70 age group. Further prospective and larger studies are needed to provide evidence-based recommendations on this topic.</p>
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