Long-term outcomes of valve replacement with modern prostheses in young adults

Abstract

Late outcomes of modern prosthetic valves in young adults remain suboptimal. Bioprostheses deserve consideration in the aortic position, as mechanical valves are associated with lower physical capacity, a higher prevalence of disability, and poorer disease perception. Early surgical referral and atrial fibrillation surgery may improve survival after MVR.

Two-Year Outcomes after Transcatheter or Surgical Aortic-Valve Replacement

“…At 2 years, there were no significant differences in mortality from any cause between the TAVR group (33.9%; 95% CI, 28.9 to 39.0) and the surgery group (35.0%; 95% CI, 29.8 to 40.2; P = 0.78) ( Table 1). Cardiovascular mortality at 2 years was also similar in the TAVR and surgery groups (21.4% [95% CI, 16.8 to 26.0] and 20.5% [95% CI, 15.8 to 25.3], respectively; P = 0.80). Similarly, in the as-treated analysis, the TAVR and surgery groups did not differ significantly with respect to all-cause mortality (33.9% and 32.7%, respectively; P = 0.75) or cardiovascular mortality (20.8% and 18.5%, respectively; P = 0.50) ( Table 2 in the Supplementary Appendix).…”

“…Nevertheless, structural valve deterioration is well known with surgical bioprostheses, and definitive assessments of valve durability will require much longer follow-up. [24][25][26] A design limitation of transcatheter aortic valves has been paravalvular regurgitation, which results from incomplete circumferential apposition of the prosthesis with the annulus. Several reports have indicated a relation between paravalvular regurgitation and mortality, but the certainty of these findings has been limited by the lack of standardization of methods to assess aortic regurgitation.…”

Reoperation of Left Heart Valve Bioprostheses According to Age at Implantation

“…[2][3][4][5][6][7][8] Younger patients also may opt for a bioprosthesis at the time of valve surgery to avoid long-term oral anticoagulation, which is associated with hemorrhage and worse disease perception. 9 Recent North American data indicate that bioprostheses are increasingly used in patients less than 65 years of age who undergo aortic valve replacement (AVR) or mitral valve replacement (MVR). 10 -12 We and others have shown that patients between 18 and 60 years of age who select a bioprosthesis at the time of initial heart valve surgery have an increased reoperation risk but experience no long-term survival detriment compared with patients who select a mechanical valve.…”

Operación de Ross en Chile

“…La implementación de la Operación de Ross en nuestro medio se puede hacer con resultados operatorios satisfactorios y comparables a los re portados para el reemplazo valvular aórtico con prótesis convencionales 11 . El número de pacientes presentados en esta serie nos permite analizar los problemas de la curva de aprendizaje.…”