Use of mechanical and biological prostheses in the aortic valve position in elderly and older patients: immediate results
Authors:
Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation
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Type: Original articles
DOI:
For citation: Chabaidze T.A., Muratov R.M., Sigaev I.Yu., Keren M.A., Zhelikhazheva M.V., Tsiskaridze I.M. Use of mechanical and biological prostheses in the aortic valve position in elderly and older patients: immediate results. Creative Cardiology. 2024; 18 (3): 362–373 (in Russ.). DOI: 10.24022/1997-3187-2024-18-3-362-373
Received / Accepted: 20.06.2024 / 31.07.2024
Keywords: prosthetics aortic valve age patients mechanical prostheses biological prostheses aortic valve prostheses aortic stenosis
Abstract
Objective. The purpose of the research is to evaluate the immediate results of aortic valve replacement using mechanical and biological prostheses in elderly and senile patients.
Material and methods. A retrospective non-randomized research included 489 patients aged 60 years and older with aortic valve defect, in accordance with the inclusion and exclusion criteria, two observation groups were formed: group 1 – patients who had aortic valve replacement (AVR) using mechanical prostheses (n = 256); group 2 – patients who underwent AVR using biological prostheses (n = 233). The immediate results after aortic valve replacement in elderly and senile patients were assessed. Endpoints: all-cause death, valve-related complications: lethal and non-lethal (prosthetic valve thrombosis, prosthetic endocarditis, small and large haemorrhage, paraprosthetic fistulae, thromboembolic complications, prosthetic valve dysfunction). Additionally, during the hospital follow-up period, the frequency of postoperative complications (acute heart failure, stroke, myocardial infarction, multiple organ failure, acute bleeds, etc.) was evaluated, a risk of lethal outcome was assessed depending on the type of implanted prosthesis, as well as fatal and non-fatal risk factors.
Results. The type of implanted valve prosthesis (mechanical or biological) doesn’t affect the incidence of lethal outcome and valve-related non-fatal complications in the immediate postoperative period, elderly and senile age wasn’t an operational risk factor for patients referred for aortic valve replacement with cardiopulmonary bypass. Elderly and senile age wasn’t an operational risk factor for patients who needed aortic valve replacement with cardiopulmonary bypass. Independent risk factors for in-hospital mortality are: class IV chronic heart failure (NYHA) (odds ratio (OR) 27.938; confidence interval (CI) 95% 3.304–236.276, p = 0.002), previous myocardial infarction (OR 4,253; CI 95% 1.765–10.247, p = 0.001), previous acute cerebrovascular disease (OR 4.022; CI 95% 1.477–10.957, p = 0.006), chronic kidney disease stage 3b (GFR<60 ml/min/1.73m2) (OR 3.279; CI 95% 1.504–7,149, p = 0.003), radiation therapy in the anamnesis (OR 17.333; CI 95% 1.046–287.436, p = 0.046).
Conclusion. The type of implanted prosthesis and the elderly age of the patient weren’t statistically significant risk factors. Concomitant diseases affecting the postoperative period were significant risk factors of hospital mortality.
References
- Bockeria L.A., Milievskaya E.B., Pryanishnikov V.V., Yurlov I.A. Cardiovascular surgery – 2022. Diseases and congenital anomalies of the circulatory system. Moscow; 2023 (in Russ.).
- TAVI Fails Noninferiority to Surgery in Younger Patients 2024. https://www.medscape.com/viewarticle/tavi-fails-noninferiority-surgery-younger-patients-2024a1000bnn?form=fpf
- Otto C.M., Nishimura R.A., Bonow R.O., Carabello B.A., Erwin J.P., 3rd, Gentile F. et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines Circulation. 2021; 143: e72–e227. DOI: 10.1161/CIR.0000000000000923
- Chikwe J., Egorova N.N., Adams D.H. Age cutoffs for bioprosthetic vs mechanical aortic valve replacement–reply. JAMA. 2015; 313: 523–524. DOI: 10.1001/jama.2014.17231.
- Head S.J., Çelik M., Kappetein A.P. Mechanical versus bioprosthetic aortic valve replacement. Eur. Heart J. 2017; 38 (28): 2183–2191. DOI: 10.1093/eurheartj/ehx141
- Diaz R., Hernandez-Vaquero D., Alvarez-Cabo R., Avanzas P., Silva J., Moris C., Pascual I. Long-term outcomes of mechanical versus biological aortic valve prosthesis: Systematic review and meta-analysis. J. Thorac. Cardiovasc. Surg. 2019; 158 (3): 706–714.e18. DOI: 10.1016/j.jtcvs.2018.10.146
- Vahanian A., Beyersdorf F., Praz F., Milojevic M., Baldus S., Bauersachs J. et al. ESC/EACTS Scientific Document Group, ESC National Cardiac Societies, 2021 ESC/EACTS Guidelines for the management of valvular heart disease: developed by the TaskForce for the management of valvular heart disease of the European Society of Cardiology (ESC) and the EuropeanAssociation for Cardio-Thoracic Surgery (EACTS). Eur. Heart J. 2022; 43 (7): 561–632. DOI: 10.1093/eurheartj/ehab395
- Zhao D.F., Seco M., Wu J.J., Edelman J.B., Wilson M.K., Vallely M.P. et al. Mechanical versus bioprosthetic aortic valve replacement in middle-aged adults: a systematic review and meta-analysis. Ann. Thorac. Surg. 2016; 102 (1): 315–327. DOI: 10.1016/j.athoracsur.2015.10.092
- Reardon M.J., Van Mieghem N.M., Popma J.J., Kleiman N.S., S0ndergaard L., Mumtaz M. et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N. Engl. J. Med. 2017; 376: 1321–1331. DOI: 10.1056/NEJMoa1700456
- Cappabianca G., Ferrarese S., Musazzi A., Terrieri F., Corazzari C., Matteucci M. et al. Predictive factors of long-term survival in the octogenarian undergoing surgical aortic valve replacement: 12-year single centre follow up. Heart Vessels. 2016; 31 (11): 1798–1805. DOI: 10.1007/s00380-016-0804-3
- Thourani V.H., Myung R., Kilgo P., Thompson K., Puskas J.D., Lattouf O.M. et al. Long-term outcomes after isolated aortic valve replacement in octogenarians: a modern perspective. Ann. Thorac. Surg. 2008; 86 (5): 1458–1464; discussion 1464–1465. DOI: 10.1016/j.athoracsur.2008.06.036
- Varadarajan P., Kapoor N., Bansal R.C., Pai R.G. Clinical profile and natural history of 453 nonsurgically managed patients with severe aortic stenosis. Ann. Thorac. Surg. 2006; 82 (6): 2111–2115. DOI: 10.1016/j.athoracsur.2006.07.048
- Skopin I.I., Otarov A.M. Preoperative risk factors in aortic valve replacement in elderly and senile patients. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2017; 18 (3): 243–255 (in Russ.). DOI: 10.24022/1810-0694-2017-18-3-243-255
- Nikitina T.G., Pelekh D.M., Filippkina T.Yu., Rybka M.M., Muratov R.M., Mironenko V.A. et al. Analysis of early postoperative complications after valve defect correction in elderly patients under cardiopulmonary bypass. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2022; 6 (23): 633–643 (in Russ.). DOI: 10.24022/1810-0694-2022-23-6-633-643
- Nguyen D.T., Delahaye F., Obadia J.F., Duval X., Selton-Suty C., Carteaux J.P. et al. Aortic valve replacement for active infective endocarditis: 5-year survival comparison of bioprostheses, homografts and mechanical prostheses. Eur. J. Cardiothorac. Surg. 2010; 37 (5): 1025–1032. DOI: 10.1016/j.ejcts.2009.11.035
- Mannacio V., Mannacio L., Mango E., Antignano A., Mottola M., Caparrotti S. Severe prosthesis-patient mismatch after aortic valve replacement for aortic stenosis: Analysis of risk factors for early and long-term mortality. J. Cardiol. 2017; 69 (1): 333–339. DOI: 10.1016/j.jjcc.2016.07.003
- Kakabaev D.B., Skopin I.I., Kakhktsyan P.V., Otarov A.M., Slivneva I.V., Vavilov A.V. et al. Surgical revascularization of the myocardium as a factor in optimizing treatment outcomes for heart valve diseases in elderly patients. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2019; 20 (9–10): 790–798 (in Russ.). DOI: 10.24022/1810-0694-2019-20-9-10-790-798
About Authors
- Tamara A. Chabaidze, Cardiologist; ORCID
- Ravil M. Muratov, Dr. Med. Sci., Professor, Head of Department, Cardiovascular Surgeon; ORCID
- Igor Yu. Sigaev, Dr. Med. Sci., Professor, Head of Department, Cardiovascular Surgeon; ORCID
- Milena A. Keren, Dr. Med. Sci., Senior Researcher, Professor, Cardiologist; ORCID
- Madina V. Zhelikhazheva, Dr. Med. Sci., Senior Researcher, Cardiologist; ORCID
- Irma M. Tsiskaridze, Cand. Med. Sci., Leading Researcher, Cardiovascular Surgeon; ORCID