Comparison of clinical outcomes in patients undergoing mitral valve replacement with mechanical or biological substitutes: a 20 years cohort

Autor: Angela Henrique Silva Ribeiro, Paulo Dornelles Picon, Luciana Eltz Soares, Orlando Carlos Belmonte Wender, Adriana Silveira de Almeida
Rok vydání: 2014
Předmět:
Male
Reoperation
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Heart Valve Diseases
Mitral valve surgery
Kaplan-Meier Estimate
Postoperative Hemorrhage
Prosthesis Design
Prosthesis
Disease-Free Survival
Risk Factors
Mitral valve
Mechanical prostheses
Humans
Medicine
Mitral prosthesis
Mortality
Aged
Proportional Hazards Models
Retrospective Studies
Bioprosthesis
Heart Valve Prosthesis Implantation
Chi-Square Distribution
Bioprostheses
Predictors
business.industry
Mitral valve replacement
Retrospective cohort study
Middle Aged
Prosthesis Failure
Cardiac surgery
Surgery
Treatment Outcome
medicine.anatomical_structure
Heart Valve Prosthesis
Multivariate Analysis
Cohort
Mitral Valve
Female
Cardiology and Cardiovascular Medicine
business
Chi-squared distribution
Brazil
Research Article
Cohort study
Zdroj: BMC Cardiovascular Disorders
ISSN: 1471-2261
DOI: 10.1186/1471-2261-14-146
Popis: Background The choice of prosthesis for mitral valve replacement still remains controversial. This study assessed mortality, bleeding events and reoperation in patients who underwent mitral valve replacement surgery with biological or mechanical substitutes. Methods A total of 352 patients who underwent mitral valve replacement surgery between 1990 and 2008 with 5 to 23 years of follow-up were retrospectively evaluated in a cohort study. Results The 5, 10, 15 and 20 year survival rates after surgery using a mechanical substitute were 87.7%, 74.2%, 69.3% and 69.3%, respectively, while after surgery with a biological substitute, they were 87.6%, 71.0%, 64.2% and 56.6%, respectively. There was no significant difference between the two groups (p = 0.38). In the multivariate analysis, the factors associated with death were age, bleeding events and renal failure. The probabilities of remaining free of reoperation at 5, 10, 15 and 20 years after surgery using a mechanical substitute were 94.4%, 92.7%, 92.7% and 92.7%; after surgery with a bioprosthesis, they were 95.9%, 86.4%, 81.2% and 76.5%, respectively (p = 0.073). There was a significantly higher incidence of reoperation for the bioprosthetic valve replacement group (p = 0.008). The probabilities of remaining free of bleeding events at 5, 10, 15 and 20 years after surgery using a mechanical substitute were 95.0%, 91.0%, 89.6% and 89.6%, respectively, while after surgery with a bioprosthesis, they were 96.9%, 94.0%, 94.0% and 94.0%, (p = 0.267). Conclusions The authors concluded that: 1) mortality during follow-up was statistically similar for both groups; 2) there was a greater tendency to reoperation in the bioprosthesis group; 3) the probability of remaining free from reoperation remained unchanged after 10 years’ follow-up for patients with mechanical substitute valves; 4) the probability of remaining fee from bleeding events remained unchanged after 10 years’ follow-up for patients given bioprostheses; 5) the baseline characteristics of patients were the greatest determinants of later mortality after surgery; 6) the type of prosthesis was not an independent predictive factor of any of the outcomes tested in the multivariate analysis.
Databáze: OpenAIRE
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