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

BMC Cardiovascular Disorders

Research Article

Adriana Silveira de Almeida¹  Paulo Dornelles Picon²  Angela Henrique Silva Ribeiro³  Orlando Carlos Belmonte Wender⁴  Luciana Eltz Soares⁵ 

[1] Cardiology and Cardiovascular Sciences of the Federal University of Rio Grande do Sul (UFRGS), Cardiovascular Surgery, Cardiovascular Surgery of Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil;Cardiology by Federal University of Rio Grande do Sul (UFRGS), Internal Medicine, Medical School at UFRGS, Clinical Pharmacology at University of Passo Fundo, Porto Alegre, Rio Grande do Sul, Brazil;Clinical Medicine of the Federal University of Rio Grande do Sul (UFRGS), Av. Francisco Trein, 596, sala 201, RS 91350-200, Porto Alegre, Brazil;Clinical Medicine of the Federal University of Rio Grande do Sul (UFRGS), Av. Francisco Trein, 596, sala 201, RS 91350-200, Porto Alegre, Brazil;Surgery Department of the Faculty of Medicine, Federal University of Rio Grande do Sul (UFRGS), Cardiovascular Surgery Service for the Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil;Faculty of Medicine of the Federal University of Rio Grande do Sul (UFRGS), National Council for Scientific and Technological Development (CNPq), Porto Alegre, Rio Grande do Sul, Brazil;

关键词: Mitral valve surgery;    Mitral prosthesis;    Bioprostheses;    Mechanical prostheses;    Predictors;    Mortality;   

DOI  :  10.1186/1471-2261-14-146

 received in 2014-06-24, accepted in 2014-09-29,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsA 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.ResultsThe 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).ConclusionsThe 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.

【 授权许可】

CC BY   
© Ribeiro et al.; licensee BioMed Central Ltd. 2014