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The fate of small-size pericardial heart valve prostheses in an older patient population
The fate of small-size pericardial heart valve prostheses in an older patient population
- Source :
- The Journal of Thoracic and Cardiovascular Surgery. 153:31-39.e2
- Publication Year :
- 2017
- Publisher :
- Elsevier BV, 2017.
-
Abstract
- Background Structural valve deterioration (SVD) is the Achilles' heel of bioprostheses. Its correlation with younger age is well known. In recent years we exclusively reserved use of small-size Mitroflow valve prostheses (LivaNova, London, United Kingdom) to an older patient population with small aortic annuli. This study aimed to assess the incidence of SVD and its effect on patient survival and need for reoperation. Materials and Methods Two hundred five patients (aged 75.9 ± 5.3 years; range, 62-92 years) underwent aortic valve replacement with a 19-mm or 21-mm Mitroflow valve prosthesis between 2005 and 2011. The great majority was female (n = 170; 83%). In half of patients it was an isolated procedure. All valve prostheses were implanted in a supra-annular position using pledgeted sutures. A 19-mm valve was implanted in 93 patients (45.3%), whereas in 112 patients (54.6%) a 21-mm valve was used. Results Twenty-three patients (11.2%) were diagnosed with early SVD by echocardiography. Average time from surgery to diagnosis of SVD was 64.3 ± 26.8 months. Ten patients needed a reoperation for SVD. Average time from surgery to a second operation was 45.7 ± 35.7 months. Overall survival was 64.5% and 42.3% at 5 and 9 years, respectively. Cumulative freedom from SVD at 5 and 9 years was 94.8% ± 1.6% and 77.4% ± 5.4%, respectively. In 4 patients death was linked to the presence of SVD. There were no differences in mortality, reoperation, or SVD between the 2 Mitroflow valve sizes. Conclusions Small-size Mitroflow pericardial valve prostheses have shown a worrisome incidence of SVD even in patients aged >70 years. Based on this experience we have discontinued their use.
- Subjects :
- Male
Pulmonary and Respiratory Medicine
Aortic valve
medicine.medical_specialty
Heel
Younger age
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
Aortic valve replacement
Risk Factors
Internal medicine
Humans
Medicine
Heart valve
Aged
Retrospective Studies
Aged, 80 and over
Bioprosthesis
Heart Valve Prosthesis Implantation
Ejection fraction
business.industry
Incidence (epidemiology)
Age Factors
Middle Aged
medicine.disease
Prosthesis Failure
Surgery
Patient population
medicine.anatomical_structure
030228 respiratory system
Echocardiography
Aortic Valve
Heart Valve Prosthesis
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 00225223
- Volume :
- 153
- Database :
- OpenAIRE
- Journal :
- The Journal of Thoracic and Cardiovascular Surgery
- Accession number :
- edsair.doi.dedup.....20c6562a91629f94e83b96eafc1218db
- Full Text :
- https://doi.org/10.1016/j.jtcvs.2016.08.063