Bioprosthetic or mechanical heart valves: prosthesis choice for borderline patients?—Results from 9,616 cases recorded in Polish national cardiac surgery registry

Abstract

Background: In middle-aged patients undergoing aortic valve replacement (AVR), the selection of prosthesis type is a complex process. Current guidelines do not unequivocally indicate the type of prosthesis (bioprosthetic or mechanical) recommended for patients between 60-70 years of age. The aim of the study was to present the trends in AVR prosthesis selection in borderline patients over a 10-year period, based on real-life registry data. Methods: The study population comprised of 9,616 consecutive patients aged between 60-70 years, who underwent isolated AVR between 2006 and 2016 in all cardiac surgery departments in Poland. Data were extracted from the Polish National Registry of Cardiac Surgery. Results: Among 27,797 consecutive AVR procedures, patients aged 60-70 years represented 34.6% of the population operated on. From 2006 to 2016, bioprosthetic valves (BVs) were implanted in 53.9% cases, (and) mechanical valves (MVs) in 42.1%. The proportion of different valve types changed in time: from 77.5% of MVs vs. 22.5% of BVs in 2006 to 23.2% of MVs vs. 76.8% of BVs in 2016 (P<0.001). The most commonly implanted BV was the Hancock II (used in 36.4% of BV implantations), the most commonly used MV was the Saint Jude Mechanical prosthesis (implanted in 36.4% of MV implantation cases). A multivariable model identified smaller annulus [OR (95% CI) 0.89 (0.86-0.92), P<0.001], atrial fibrillation [OR (95% CI) 1.32 (1.05-1.67), P=0.017], male sex [OR (95% CI) 1.47 (1.24-1.74), P<0.001] and year of implantation [OR (95% CI) 0.75 (0.71-0.79), P<0.001] as predictors of MV implantation. Conclusions: Patients aged 60-70 years represent more than one-third of all AVR patients. Between 2006 and 2016, the proportion of implanted prostheses has changed dramatically. In 2016 BVs were implanted in nearly 75% of AVR cases, three times more often than in 2006.The forms were reviewed for clinical face validity and analytical internal validity. On the basis of the form of the National Registry of Cardiac Surgery (KROK), a computer database was built for statistical analysis. Study population and clinical variablesUsing the KROK database, we identified patients who underwent isolated AVR as the first cardiosurgical

Mechanical versus Bioprosthetic Aortic Valve Replacement in Middle-Aged Adults: A Systematic Review and Meta-Analysis

“…In total, 22 studies were included in the final analysis, and the characteristics of the individual studies are summarized in Table 1 . Of those studies, one was an RCT study [ 8 ], 11 were PSM retrospective studies [ 1 , 3 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ], and 10 were non-PSM retrospective studies [ 7 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. In total, 32,298 patients were included, of which 15,449 received mechanical prostheses, whereas 16,849 received biological prostheses.…”

“…It is acknowledged that mechanical prostheses are more likely to be recommended to younger patients (American Heart Association/American College of Cardiology guideline: <50 years old; European Society of Cardiology/European Association for Cardio-Thoracic Surgery guideline: <60 years old), whereas bioprosthetic prostheses are more likely to be recommended to elderly patients (American Heart Association/American College of Cardiology guideline: >70 years old; European Society of Cardiology/European Association for Cardio-Thoracic Surgery guideline: >65 years old) [ 4 , 5 ]. Although the use of bioprosthetic implantations has been increasing in all age periods in recent years, it is still undecided as to which prosthesis is better for middle-aged patients (aged from 50 to 70 years) [ 6 , 7 ]. Several studies have focused on this topic, but the conclusions are varied.…”

Long-term survival following postoperative myocardial infraction after coronary artery bypass surgery

“…Data was collected retrospectively from the KROK registry (Polish National Registry from Cardiac Surgery Procedures) (available at https://www.krok.csioz.gov.pl). The registry is an ongoing, nationwide, multi-institutional registry for all general cardiac surgery in Poland that collects in-hospital data on patients and outcomes; details of the registry design have been described in other papers (13)(14)(15)(16). Long-term survival data are transmitted directly to the registry from follow-up mortality data obtained from National Health Fund-the nationwide, mandatory, public health insurance institution in Poland-and included in the registry (13).…”

“…The data presented in this study are based on the experience of a single center. Limitations of the KROK registry have been described previously (14)(15)(16)29). The KROK registry does not capture rates of long-term stroke and other MACCE complications.…”

Early experience with the Thopaz+ chest drainage system – is this a new era in the management of post-cardiotomy bleeding?

“…Currently, there are 36 cardiac surgery centers in Poland, where about 20 000 procedures are performed every year. Based on data from Polish National Cardiac Surgery Registry, the number of cardiac surgical procedures is systematically increasing [ 1 – 3 ]. Every procedure requires postoperative drainage to avoid complications due to accumulation of fluid, serum and blood [ 4 – 6 ].…”