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Biological or mechanical aortic prostheses in patients aged 40-60 years : a single centre experience
Session:
Prémio Manuel Machado Macedo
Speaker:
Inês Alves
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Prémios
FP Number:
---
Authors:
Inês Alves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Introduction: </span></strong>The choice of prostheses type when performing surgical aortic valve replacement (SAVR) remains controversial in middle aged patients. Mechanical prostheses are associated with risks due to the need of anticoagulation therapy, while biological valves have a higher risk of deterioration. In recent guidelines, the ESC/EACTS recommends mechanical valves should be considered in patients <60 and biological valves in patients >65. US guidelines recommend either biologic or mechanical prostheses in patients aged 50 to 70 years. </span></span> <span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Baseline characteristics, life expectancy, contraindications for anticoagulation and patient preference are also considered in prostheses choice. Despite guidelines, biological valve use has increased over the last decades in all age groups We set out to study long-term outcomes of mechanical versus biologic prostheses in patients aged 40-60 years and analyse the use of biological valves in this group.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Methods:</span></strong> We performed a single-centre retrospective observational study. Patients aged 40 to 60 that underwent SAVR in our centre from 2006 to 2016 were included (n=383). The primary outcome was all-cause long-term mortality or aortic valve reoperation within the study time. Univariable analysis of relevant variables was performed comparing patients who underwent mechanical (n=343) or biological (n=40) prostheses. A propensity score nearest neighbour matching (1:1) for the biological valves group using the statistically different variables was used. Primary outcome was studied using Kaplan Meier Curves. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Results:</span></strong> Mean follow-up was 10,7 years. Mortality or reoperation was 19.8% in the mechanical and 35% in the biological prostheses. In the overall study group, mortality was significantly higher in the biological group, but when applied to the propensity matched sample, mortality was significantly higher in the mechanical group (figure 1 and 2). When comparing the population and propensity matched sample, the later showed higher pre-op chronic kidney disease (p=0.024) and stroke (p=0.002), lower left ventricle ejection fraction (p<0.001) and more post-operative complications (p=0.021). Overall survival was lower in the matched group.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Conclusion:</span></strong> The present study has limitations, including the type of study and reduced number of patients, that can account for some of the results found. However, based on our centre’s experience we hypothesize that in a select group of patients, even in younger ages, the use of biological protheses may prove beneficial, highlighting the importance of the patient’s comorbidities and characteristics in prostheses choice. Further studies to analyse these findings could be beneficial, since very few other studies focused on this age group were found.</span></span></p>
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