2 research outputs found
Biological or mechanical prostheses for isolated aortic valve replacement in patients aged 50-65 years: the ANDALVALVE study
[Objectives]: The decision about whether to use a biological or a mechanical prosthesis for aortic valve replacement remains controversial in patients between 50 and 65 years of age and has yet to be addressed in a Mediterranean population. This research aimed to analyse long-term survival and major morbidity rates (30-day mortality, stroke, any prosthetic reoperation and major bleeding) within this population.
[Methods]: Our multicentre observational retrospective study included all subjects aged 50–65 years who had a primary isolated aortic valve replacement due to severe aortic stenosis at 7 public hospitals from Andalusia (Spain) between 2000 and 2015. Concomitant surgery, reoperations and endocarditis were the exclusion criteria. A total of 1443 patients were enrolled in the study (272 with biological and 1171 with mechanical valves). Multivariate analyses including a 2:1 propensity score matching (506 mechanical and 257 biological prostheses) were conducted.
[Results]: Bioprostheses were implanted in 18.8% (n = 272): 35% were women; the mean EuroSCORE-I was 3%. The mean follow-up was 8.1 ± 4.9 years in a matched sample: 8.8 ± 4.9 years in those receiving a mechanical vs 7.1 ± 4.5 years in those receiving a biological prosthesis (P = 0.001). In the paired sample, the 15-year survival rate was 73% in those who had a biological vs 76% in those who had a mechanical valve [hazard ratio (HR) 0.80, 95% confidence interval (CI) 0.54–1.20; P = 0.159]. No significant differences were observed in patients ≥55 years old (74% of 15-year survival in both groups: HR 0.88, 95% CI 0.56–1.34; P = 0.527). A higher rate of major bleeding was found in patients with a mechanical prosthesis (P = 0.004), whereas reoperation was more frequent among those with a biological prosthesis (P = 0.01).
[Conclusions]: Long-term survival was comparable in patients above 55 years of age. Mechanical prostheses were associated with more major bleeding and bioprostheses, with more reoperations. A bioprosthesis in patients above 55 years old is a reasonable choice.This work was supported by Edwards Lifesciences, which provided funds for an independent statistical analysis
Comparativa de la reparación valvular mitral y el dispositivo MitraClip® en el tratamiento de la insuficiencia mitral severa
IntroducciĂłn: La insuficiencia mitral sintomática tiene pronĂłstico desfavorable sin tratamiento quirĂşrgico. Esto lleva al desarrollo de tĂ©cnicas menos invasivas para pacientes no candidatos a cirugĂa. Se trata de analizar los resultados del tratamiento percutáneo (MitraClip®) y compararlo con la reparaciĂłn mitral.
MĂ©todos: Pacientes intervenidos en nuestro centro de insuficiencia mitral entre enero del 2011 y diciembre del 2013. Seguimiento de 2 años. Diferenciamos 2 grupos: MitraClip® (19 pacientes) y cirugĂa reparadora (31). Realizaremos un análisis comparativo de medias y proporciones mediante t de Student o ji cuadrado, respectivamente, tomando como estadĂsticamente significativas variables con p < 0,05.
Resultados: Ambos grupos fueron homogĂ©neos, excepto para diabetes (p = 0,009), insuficiencia renal (p = 0,004) y enfermedad coronaria (p = 0,030), algo superior en MitraClip®. TambiĂ©n predominĂł la miocardiopatĂa dilatada en este grupo (p = 0,001).
Resultado inmediato: insuficiencia mitral residual en el 100% de los MitraClip® frente al 39% poscirugĂa (OR 2,6; p < 0,001). Complicaciones inmediatas: un Ăşnico fallecido en el grupo MitraClip®. Necesidad de transfusiones, marcapasos transitorio y aminas ligeramente superior en el grupo quirĂşrgico (p < 0,001).
Estancia hospitalaria (p = 0,001) y tiempo de intervención (p = 0,039) menores en el grupo quirúrgico. Seguimiento a 2 años: progresión de al menos un grado de insuficiencia en MitraClip®. Ausencia de insuficiencia o grado i en un 97% de los quirúrgicos. Mas reingresos (p = 0,033) y muertes (p = 0,0095) en MitraClip®, no existiendo en el grupo quirúrgico.
Conclusiones: El dispositivo MitraClip®, en este grupo de bajo riesgo, mostrĂł peores resultados con mayor mortalidad, reingresos, descompensaciones y alta tasa de insuficiencia mitral residual. PodrĂa ser una alternativa en casos desestimados de cirugĂa