Perioperative events in patients with failed mechanical and bioprosthetic valves (original) (raw)
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Factors influencing mortality after bioprosthetic valve replacement; a midterm outcome
Journal of cardiovascular and thoracic research, 2013
Although valve repair is applied routinely nowadays, particularly for mitral regurgitation (MR) or tricuspid regurgitation (TR), valve replacement using prosthetic valves is also common especially in adults. Unfortunately the valve with ideal hemodynamic performance and long-term durability without increasing the risk of bleeding due to long-term anticoagulant therapy has not been introduced. Therefore, patients and physicians must choose either bioprosthetic or mechanical valves. Currently, there is an increasing clinical trend of using bioprosthetic valves instead of mechanical valves even in young patients apparently because of their advantages. Seventy patients undergone valvular replacement using bioprosthetic valves were evaluated by ECG and Echocardiography to assess the rhythm and ejection fracture. Mean follow-up time was 33 months (min 9, max 92). Mortality rate was 25.9% (n=18) within 8 years of follow-up. Statistical analysis showed a significant relation between atrial ...
Reoperation on prosthetic heart valves
The Journal of Thoracic and Cardiovascular Surgery, 1995
Reoperation on prosthetic heart valves is increasingly under consideration for both clinical and prophylactic indications. To determine the correlates of hospital events, including in-hospital mortality, new persisting neurologic deficit, and length of postoperative stay, a three-institution study of 2246 consecutive prosthetic valve reoperations performed on 1984 patients between 1963 and 1992 was undertaken. The combined experience ranged from high-risk patients coming moribund to the operating room to an important number of well individuals undergoing prophylactic reoperations on potentially failing valves. The risk-unadjusted hospital mortality was 10.8%, neurologic deficit at hospital discharge 1.1%, and length of stay 10 days (median). Multivariably determined correlates of outcome included age at reoperation, degree, severity, and acuity of impairment of cardiac function, extensiveness of valvular heart disease, coexisting morbid conditions, number of previous heart operations, and concomitant procedures. The risk-adjusted hospital mortality for the first elective reoperation in a good-risk patient was 1.3% (90% confidence limits 0.3% to 4.4%), neurologic deficit 0.3% (90% confidence limits 0.02% to 1.8%), and length of postoperative stay 7 days (9t)% confidence limits 4 to 13), emphasizing the wide variance in outcome events. Equations were developed to permit wide application of the results of the study for quantitatively estimating the risk of outcome events based on individual preoperative patient characteristics. These estimates should be useful for informed patient consent, considerations of prophylactic valve replacement, and cost and resource use. (J TttORAC CARDIOVASC SURG 1995;109:30-48)
Late incidence and determinants of reoperation in patients with prosthetic heart valves
European Journal of Cardio-Thoracic Surgery, 2004
Objectives: Reoperation is a relatively common event in patients with prosthetic heart valves, but its actual occurrence can vary widely from one patient to another. With a focus on bioprosthetic valves, this study examines risk factors for reoperation in a large patient cohort. Methods: Patients ðN ¼ 3233Þ who underwent a total of 3633 operations for aortic (AVR) or mitral valve replacement (MVR) between 1970 and 2002 were prospectively followed (total 21179 patient-years; mean 6.6^5.0 years; maximum 32.4 years). The incidence of prosthetic valve reoperation and the impact of patient-and valve-related variables were determined with actual and actuarial methods. Results: Fifteenyear actual freedom from all-cause reoperation was 94.1% for aortic mechanical valves, 61.4% for aortic bioprosthetic valves, 94.8% for mitral mechanical valves, and 63.3% for mitral bioprosthetic valves. In both aortic and mitral positions, current bioprosthesis models had significantly better durability than discontinued bioprostheses (15-year reoperation odds-ratio 0.11^0.04; P , 0:001 for aortic, and 0.42^0.14; P ¼ 0:009 for mitral). Current bioprostheses were significantly more durable in the aortic position than in the mitral position (14.3^6.8% more freedom from 15-year reoperation; P ¼ 0:018). Older age was protective, but smoking was an independent risk factor for reoperation after bioprosthetic AVR and MVR (hazard ratio for smoking 2.58 and 1.78, respectively). In patients with aortic bioprostheses, persistent left ventricular hypertrophy at follow-up and smaller prosthesis size predicted an increased incidence of reoperation, while this was not observed in patients with mitral bioprostheses. Conclusions: These analyses indicate that current bioprostheses have significantly better durability than discontinued bioprostheses, reveal a detrimental impact for smoking after AVR and MVR, and indicate an increased reoperation risk in patients with a small aortic bioprosthesis or with persistent left ventricular hypertrophy after AVR. q
European Journal of Cardio-thoracic Surgery, 2002
Objectives: The purpose of the study was to analyze risk factors for hospital mortality in patients undergoing valvular reoperations for prosthetic valve dysfunction. Methods: We performed a prospective analysis of 146 patients who underwent valvular reoperations for prosthetic valve dysfunction between July 1995 and June 1999 at the Heart Institute of the University of São Paulo Medical School. Multivariate statistical analysis with logistic regression was used to analyze preoperative and intraoperative variables to determine risk factors for hospital mortality. Results: The overall hospital mortality was 10.9% (16 patients). Univariate analysis showed that the following variables were associated with higher mortality rates: advanced New York Heart Association (NYHA) functional class, increased creatinine level, prolonged extracorporeal circulation time and treatment of annular abscess. Logistic multivariate analysis identified advanced NYHA functional class and a creatinine level higher than 1.5 mg/dl as independent predictors of hospital mortality. Conclusions: Advanced NYHA functional class and higher creatinine levels were independent predictors of hospital mortality in patients submitted for valvular reoperations for prosthetic valve dysfunction. q Almeida Brandão).
Late results of double-valve replacement with biologic or mechanical prostheses
The Annals of Thoracic Surgery, 2001
We previously showed that the risk of reoperation for structural degeneration of bioprostheses was higher in cases involving patients older than 65 years (p = 0.003) and double-valve replacement (p = 0.02). The purpose of this study was to compare late outcome of mitral-aortic valve replacement using bioprostheses or mechanical valves. The bioprosthesis group included all mainland France residents (n = 48) between 55 and 65 years old operated on between 1980 and 1995 for mitral-aortic valve replacement using bioprostheses. The mechanical valve group was obtained by matching each of these patients with a patient operated on using mechanical valves at approximately the same time during the study. In the bioprosthesis group, 10-year survival was 45%+/-8% versus 62%+/-7% in the mechanical valve group (not significant). The linearized reoperation rate was 6.8 per patient-year versus 1.1 per patient-year (p = 0.001), and the linearized reoperative mortality rate was 1.8 per patient-year and 0.7 per patient-year (not significant), respectively. The reoperative mortality risk after mitral-aortic valve replacement using two bioprostheses does not significantly decrease overall survival after age 65 years.
The Journal of Thoracic and Cardiovascular Surgery, 1994
years. Preoperatively, 830 patients (69%) were in functional class III or IV. A total of 611 patients (51 %) had the aortic valve replaced, 490 (41 %) the mitral valve, 2 (0.2 %) the tricuspid valve, and 97 (8 %) multiple valves. There were 81 hospital deaths (6.8 %). Risk factors included older age (p = 0.0001), female gender (p = 0.02), higher preoperative left ventricular end-diastolic pressure (p = 0.05), previous cardiac operation (p = 0.003), longer aortic crossclamp time (p = 0.0001), and longer cardiopulmonary bypass time (p = 0.0001). FoUow-up was 98% complete (3153 patient-years). There were 152 late deaths; 32 (21 %) were considered valve-related: six thromboembolism, four valve thrombosis, five anticoagulant-related hemorrhage, eight prosthetic valve endocarditis, one paravalvular leak, and seven sudden death. The 5-year actuarial survival was 75 %. Risk factors for late death included older age (p = 0.03), lower preoperative ejection fraction (p = 0.005), longer aortic crossclamp time (p =0.0001), longer cardiopulmonary bypass time (p =0.0001), previous cardiac operation (p = 0.02), and higher preoperative functional class (p = 0.0001). Actuarial freedom at 5 years from major thromboembolic events and anticoagulant-related hemorrhage was 97 % and 95 %, respectively. This value for valve thrombosis was 99%, for reoperation 96%, for prosthetic valve endocarditis 98%, and for paravalvular leak 96 %. Actuarial freedom from aU valve-related events and valve-related death at 5 years was 74% and 94%, respectively. We conclude that the low incidence of valve-related events and low mortality supports the continued use of the St.
African journal of Biological sciences, 2024
Background: Prosthetic heart valve replacement is the commonest choice in case of valvular failure or functional impairment. Although, they are considered to be ideal choices, they are vulnerable to dysfunction depending on various factors. Arising valvular dysfunctions are mostly related to stenosis or regurgitation. Methodology: This is a descriptive study including 30 participants out of which 17 are male and 13 are female. Subjects between 20 and 80 years of age with mitral valve replacement were included in the study with their consent. Subjects with other cardiac complications were excluded. The study was conducted for 12 months in the department of Echocardiography in a private institute for Cardiac sciences. Outcomes were assessed using ECG, ECHO, Catheterisation data, complications, type of valve used and symptoms associated with dysfunction. Results: Hypertension was seen in 50% subjects and mechanical valve was mostly used in subjects about 46.7%. observing the symptoms associated with dysfunction, syncopewas noted majorly in men about 93.3% and dyspnea was commonly seen in women about 63.3%. Dysfunction commonly occurred in 80% men on acitrom medication and 43.3% women on warfarin treatment. Conclusion: In conclusion we report that mechanical valves tend to cause valvular dysfunction alone or when supported by various other factors like use of drugs, comorbidities, social habits, and other cardiac disturbances. Although they are considered to be potentially a greater choice, they still tend to cause dysfunction which hinders the therapeutic progress. Further studies in larger sections need to be conducted to analyse the results more specifically and provide better therapeutic outcomes.