Heart Valve Prosthesis Implantation/complications

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Editorial

Mechanical Prosthesis X Biological Prosthesis: an Individualized and Shared Decision

João Ricardo C. Fernandes et al. Roney Orismar Sampaio

Surgical valve interventions are performed primarily in patients with severe valve heart disease, with associated symptoms and/or anatomical/hemodynamic consequences, and no contraindication to the procedure. The choice of prosthetic valve should be based on a shared decision-making process that must account for the trade-offs between durability (and the need for reintervention), bleeding, and thromboembolism.

The manuscript: “Late Outcomes of Aortic Valve Replacement with Bioprosthesis and Mechanical Prosthesis” is an observational retrospective study intended to evaluate the long-term follow-up of patients (n=202) who underwent aortic valve replacement, comparing biological (65.3%) and mechanical prostheses (34.7%). The patients were relatively young (mean age: 49 years), with predominantly degenerative aortic valve disease. On the other hand, 22% of the study population had rheumatic disease, the most prevalent etiology of valve disease in Brazil.

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Original Article

Late Outcomes of Aortic Valve Replacement with Bioprosthesis and Mechanical Prosthesis

Larissa Ventura Ribeiro Bruscky et al. Carlos Gun Auristela Isabel de Oliveira Ramos Alice Lemos Morais

Abstract

Background

Despite constant improvement and refinement of the prostheses, the decision between mechanical and biological valves for aortic valve replacement is still controversial.

Objective

To compare outcomes of aortic valve replacement with bioprosthesis and mechanical prosthesis.

Methods

This was an observational, historical cohort study with review of medical records. A total of 202 patients who underwent heart valve replacement surgery between 2004 and 2008 were selected, with a mean follow-up of 10 years. The level of significance set at 5%.

Results

Mean age of patients was approximately 50 years; most patients were male (70%). Overall mortality- and reoperation-free survival was significantly higher in patients with mechanical prosthesis (HR=0.33; 95%CI=0.13-0.79; p=0.013). No difference was found in late mortality between the two groups. On the other hand, the risk of reoperation was significantly higher in patients with bioprosthesis than mechanical prosthesis (HR=0.062; 95%CI=0.008-0.457; p=0.006). The risk of composite adverse events – stroke, bleeding, endocarditis, thrombosis and paravalvular leak – was similar between the groups (HR=1.20; 95%CI= 0.74-1.93; p=0.44). The risk of bleeding was significantly higher in patients with mechanical prosthesis (HR=3.65; 95%CI= 1.43-9.29; p = 0.0064), although no case of fatal bleeding was reported.

Conclusion

No difference in 10-year mortality was found between the groups. The risk of reoperation significantly increases with the use of bioprosthesis, especially for patients younger than 30 years. Patients with mechanical prosthesis are at increased risk of nonfatal bleeding.