Bioprosthetic aortic valve replacement in patients aged 50 years old and younger: Structural valve deterioration at long-term follow-up. Retrospective study.

Autor:	Corona S; Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy., Manganiello S; Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy., Pepi M; Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy., Tamborini G; Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy., Muratori M; Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy., Ali SG; Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy., Capra N; Department of Biostatistics, Centro Cardiologico Monzino, IRCCS, Milan, Italy., Naliato M; Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy., Alamanni F; Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy.; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy., Zanobini M; Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Jazyk:	angličtina
Zdroj:	Annals of medicine and surgery (2012) [Ann Med Surg (Lond)] 2022 Apr 12; Vol. 77, pp. 103624. Date of Electronic Publication: 2022 Apr 12 (Print Publication: 2022).
DOI:	10.1016/j.amsu.2022.103624
Abstrakt:	Background: Structural valve deterioration (SVD) remains the major determinant of bioprosthesis durability. The aim of this study was to investigate the SVD incidence, predictors and outcomes in patients aged 50 years and younger after bioprosthetic aortic valve replacement (bAVR). Methods: We retrospectively analyzed 73 consecutive patients ≤50 years old who underwent bioprosthetic AVR at our center between 2005 and 2015. Median age at surgery was 44 (interquartile range [IQR]: 39-47) years. Follow-up was 93.2% complete at a median time of 7.2 (IQR: 5.5-9.5) years. Cumulative follow-up was 545.5 valve-years. Bioprosthesis SVD was determined by strict echocardiographic assessment. Results: The overall survival-rate at 10/15 years and freedom from SVD at 10/12.5 years were 89.6 ± 5.2%/81.5 ± 9.1% and 73.5 ± 8.2%/41.9 ± 18.9%, respectively. SVD occurred at a median time of 8.2 (IQR: 6.0-9.9) years after bAVR. Age was not found as an independent predictor for SVD at the multivariable model, despite a higher rate of SVD in the age group ≤30 years. Freedom from reoperation due to SVD at 10/15 years was 71.3 ± 14.1%/13.6 ± 12.3%. Reoperation was performed at a median time of 10.0 (IQR: 8.9-11.9) years since first bAVR and was associated with a 100% 12-month survival. Conclusions: In our study, the rate and time of SVD occurrence were comparable to those of other studies' older age groups. Strict echocardiographic monitoring of valve performance is mandatory to set the appropriate timing of eventual reoperation. This attitude can improve outcomes of bAVR in younger patients. Competing Interests: None. (© 2022 The Authors.)
Databáze:	MEDLINE
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