Late incidence and determinants of reoperation in patients with prosthetic heart valves

Ruel, Marc; Kulik, Alexander; Rubens, Fraser D.; Bédard, Pierre; Masters, Roy G.; Pipe, Andrew; Mesana, Thierry G.

doi:10.1016/j.ejcts.2003.12.013

Cited by 138 publications

(82 citation statements)

References 22 publications

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“…Mitral valve bioprosthesis undergoes more frequent failure and tears than aortic valve bioprosthesis, related to the higher mechanical stresses on mitral valves during systole [17]. The right sided prostheses, on the other hand, last significantly longer, partly at least due to the lower pressures on this side.…”

Section: Site Of Implantationmentioning

confidence: 99%

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Bioprosthetic Heart Valves: Impact of Implantation on Biomaterials

2013

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Prosthetic heart valves are commonly used in the treatment of valvular heart disease. Mechanical valves are more durable than the bioprosthetic valves; however, the need for long-term anticoagulant therapy renders them unsuitable for some patient groups. In this paper we discuss the different types and models of bioprosthesis, and in particular, pericardial bioprosthesis. We also discuss the preimplantation preparation processes, as well as their postimplantation changes and modes of failure.

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Section: Site Of Implantationmentioning

confidence: 99%

“…Systemic hypertension (leading to chronically increased diastolic closure stress), LV hypertrophy, and poor LV function are all associated with aortic BHV failure [17]. focally with deep mononuclear inflammatory cells and occasionally a multinucleate giant cells seen close to the stent post or tear ( Figure 2).…”

Section: Comorbid Conditionmentioning

confidence: 99%

Bioprosthetic Heart Valves: Impact of Implantation on Biomaterials

2013

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“…It can be observed in most of existing publications that the risk of reoperation begins to grow after 10 years of surgery to implant of valve substitute, probably due to dysfunction of the prosthesis, and increases progressively over time, decreasing with advancing age [17,24,26,32,[36][37][38][39][40][41][42]. In this cohort, a trend was observed for reoperation after 10 years of follow-up (P=0.057), which is probably at the borderline sample descriptive level.…”

Section: Reoperationmentioning

confidence: 71%

“…Ruel et al [40] studied a cohort of 2348 patients undergoing surgery for aortic valve replacement between 1970 and 2002, with a maximum follow-up period of 32.4 years. The free time of reoperation for patients with mechanical replacement was 96.2%, 94.1% and 93.8% for 10, 15 and 20 years after surgery, respectively, similar to the data presented in this cohort.…”

Section: Reoperationmentioning

confidence: 99%

Resultados de pacientes submetidos à cirurgia de substituição valvar aórtica usando próteses mecânicas ou biológicas

Almeida

Picon

Wender

2011

Rev Bras Cir Cardiovasc

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Resultados de pacientes submetidos à cirurgia de substituição valvar aórtica usando próteses mecânicas ou biológicasOutcomes of patients subjected to aortic valve replacement surgery using mechanical or biological prosthesesThis study was carried out at Clinics Hospital of Porto Alegre, Porto Alegre, RS, Brazil. AbstractObjective: This paper evaluates outcomes in patients subjected to surgery for replacement of the aortic valve using biological or mechanical substitutes, where selection of the type of prosthesis is relevant.Methods: Three hundred and one patients, randomly selected, who had been subjected to aortic valve replacement surgery between 1990 and 2005, with a maximum follow-up period of 20 years.Results: Survival at 5, 10 and 15 years after surgery using mechanical substitute was 83.9%, 75.4% and 60.2% and, for biological substitute, was 89.3%, 70.4% and 58.4%, respectively (P=0.939). Factors associated with death were: age, obesity, pulmonary disease, arrhythmia, bleeding and aortic valve failure. Probability free of reoperation for these patients at 5, 10 and 15 years after surgery using mechanical substitute was 97.9%, 95.8% and 95.8% and, for those using bioprostheses, was 94.6%, 91.0% and 83.3%, respectively (P=0.057). Factors associated with reoperation were: renal failure, prosthesis endocarditis and age. Probability free of bleeding events at 5, 10 and 15 years after surgery using mechanical substitute was 94.5%, 91.7% and 91.7% and, for bioprostheses, was 98.6%, 97.8% and 97.8%, respectively (P=0.047). Factors associated with bleeding events were: renal failure and mechanical prostheses.Conclusions: The authors have concluded that: 1) mortality was statistically similar in the groups; 2) patient characteristics at baseline were a major determinant of late mortality after surgery; 3) there was a tendency toward reoperation in the bioprostheses group; 4) patients using mechanical prosthesis had more bleeding events as time passed; 5) data presented in this paper is in accordance with current literature. Descriptors 327Almeida AS, et al. -Outcomes of patients subjected to aortic valve replacement surgery using mechanical or biological prostheses Bras Cir Cardiovasc 2011;26(3):326-37 Rev

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“…Ten years after heart valve replacement, up to 50% of the patients require reoperation or die of complications related to the prosthetic heart valves. There is usually no difference between mechanical and biological prostheses, but the frequency and nature of the complications related to the prostheses vary according to type, model, and valve position, as well as to each patient's characteristics 4,[11][12][13][14][15] . By quantifying the comparative odds ratios between patients who presented varying degrees of prosthetic valve leak, the present study contributes to a better knowledge of its clinical outcome and provides information to guide therapies and establish prognoses.…”

Section: Discussionmentioning

confidence: 99%