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

Abstract

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

Bioprosthesis versus Mechanical Valve Heart Prosthesis: Assessment of Quality of Life

“…4 Most complications of valvular prosthesis implantation are probably related to the patient rather than the prosthesis per se. 5 In recent years, studies on QoL have been one the main objects of health studies, and has been the focus of discussion forums, lay press, and marketing of products and services. 6,7 One of the methods for assessing QoL is the Medical Outcomes Study (MOS) 36-Item Short Form Health Survey (SF-36), which was validated in Portuguese by Ciconelli et al,8 This is a generic tool for assessing QoL, easy to apply and understand and relatively short when compared to others.…”

Late outcome analysis of the Braile Biomédica® pericardial valve in the aortic position

“…The choice of which prosthesis to use - biological or mechanic - was not associated to a significant improvement in survival [ 4 , 5 ] . However, in terms of freedom from reintervention during a 20-year follow-up, bioprostheses were inferior compared to mechanical prostheses [ 5 ] .…”

Impact of socio-economic profile on the prosthesis type choice used on heart surgery

“…More than 30 years after the introduction of modern prostheses, the choice between biological and mechanical remains controversial [10]. Few randomized trials, controlled and with large numbers of patients to guide a definitive treatment of valvular heart disease.…”

“…The choice between the types of prostheses in adults is determined primarily by assessing the risk of anticoagulation related bleeding versus the risk of structural valve deterioration, but the clinical decisionmaking becomes increasingly challenging with the increase in life expectancy and the presence of comorbidities such as advanced age, congestive heart failure, coronary artery disease, pulmonary disease and renal failure [10].…”