Long-Term Survival for Patients With Preoperative Renal Failure Undergoing Bioprosthetic or Mechanical Valve Replacement

Abstract A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘In [dialysis patients undergoing a valve replacement] is [a bioprosthetic valve superior to a mechanical prosthesis] for [long-term survival and morbidity]’. Altogether more than 501 papers were found using the reported search, of which five represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. There was limited high-quality evidence with all studies being retrospective. One meta-analysis and four cohort studies provided the evidence that there was no significant difference in long-term survival based on prosthesis type. However, the majority of studies demonstrated a significantly higher rate of valve-related complications including bleeding and thromboembolism, and readmission to hospital in the mechanical valve prosthesis group, likely related to the requirement for long-term anticoagulation. We conclude that overall long-term survival in dialysis-dependent patients is poor. While prosthesis type does not play a significant contributing role to long-term survival, bioprosthetic valves were associated with significantly fewer valve-related complications. Based on the available evidence, a bioprosthetic valve may be more suitable in this high-risk group of patients as it may avoid the complications associated with long-term anticoagulation without any reduction in long-term survival.

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Long-Term Survival for Patients with Metabolic Syndrome After Bioprosthetic or Mechanical Valve Replacement

Journal of Cardiac Surgery ◽

10.1111/jocs.12246 ◽

2013 ◽

Vol 29 (1) ◽

pp. 26-34 ◽

Cited By ~ 2

Author(s):

Marek Polomsky ◽

Patrick D. Kilgo ◽

John D. Puskas ◽

Michael E. Halkos ◽

Vinod H. Thourani ◽

...

Keyword(s):

Metabolic Syndrome ◽

Valve Replacement ◽

Mechanical Valve ◽

Term Survival ◽

Long Term Survival

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Prosthesis–patient mismatch affects long-term survival after mechanical valve replacement

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2007.11.032 ◽

2008 ◽

Vol 135 (5) ◽

pp. 1076-1080 ◽

Cited By ~ 37

Author(s):

Shun Kohsaka ◽

Shaulnie Mohan ◽

Salim Virani ◽

Vei-Vei Lee ◽

Ariadna Contreras ◽

...

Keyword(s):

Valve Replacement ◽

Mechanical Valve ◽

Term Survival ◽

Long Term Survival

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Faculty Opinions recommendation of Very long-term survival implications of heart valve replacement with tissue versus mechanical prostheses in adults <60 years of age.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1097213.553222 ◽

2007 ◽

Author(s):

Francesco Maisano ◽

Anna Maria Di Blasio

Keyword(s):

Valve Replacement ◽

Heart Valve ◽

Heart Valve Replacement ◽

Term Survival ◽

Long Term Survival ◽

Mechanical Prostheses

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Faculty Opinions recommendation of Impact of Valve Replacement on Long-Term Survival in Asymptomatic Patients With Severe Aortic Stenosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735080888.793556800 ◽

2019 ◽

Author(s):

John A Paraskos

Keyword(s):

Aortic Stenosis ◽

Valve Replacement ◽

Severe Aortic Stenosis ◽

Term Survival ◽

Long Term Survival ◽

Asymptomatic Patients

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Long-term survival after Carpentier-Edwards Perimount aortic valve replacement in Western Denmark: a multi-centre observational study

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01506-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Lytfi Krasniqi ◽

Mads P. Kronby ◽

Lars P. S. Riber

Keyword(s):

Risk Factors ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Significant Risk ◽

Valve Prosthesis ◽

Term Survival ◽

Long Term Survival ◽

All Cause Mortality

Abstract Background This study describes the long-term survival, risk of reoperation and clinical outcomes of patients undergoing solitary surgical aortic valve replacement (SAVR) with a Carpentier-Edwards Perimount (CE-P) bioprosthetic in Western Denmark. The renewed interest in SAVR is based on the questioning regarding the long-term survival since new aortic replacement technique such as transcatheter aortic-valve replacement (TAVR) probably have shorter durability, why assessment of long-term survival could be a key issue for patients. Methods From November 1999 to November 2013 a cohort of a total of 1604 patients with a median age of 73 years (IQR: 69–78) undergoing solitary SAVR with CE-P in Western Denmark was obtained November 2018 from the Western Danish Heart Registry (WDHR). The primary endpoint was long-term survival from all-cause mortality. Secondary endpoints were survival free from major adverse cardiovascular and cerebral events (MACCE), risk of reoperation, cause of late death, patient-prothesis mismatch, risk of AMI, stroke, pacemaker or ICD implantation and postoperative atrial fibrillation (POAF). Time-to-event analysis was performed with Kaplan-Meier curve, cumulative incidence function was performed with Nelson-Aalen cumulative hazard estimates. Cox regression was applied to detect risk factors for death and reoperation. Results In-hospital mortality was 2.7% and 30-day mortality at 3.4%. The 5-, 10- and 15-year survival from all-cause mortality was 77, 52 and 24%, respectively. Survival without MACCE was 80% after 10 years. Significant risk factors of mortality were small valves, smoking and EuroSCORE II ≥4%. The risk of reoperation was < 5% after 7.5 years and significant risk factors were valve prosthesis-patient mismatch and EuroSCORE II ≥4%. Conclusions Patients undergoing aortic valve replacement with a Carpentier-Edwards Perimount valve shows a very satisfying long-term survival. Future research should aim to investigate biological valves long-term durability for comparison of different SAVR to different TAVR in long perspective.

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The Prospects of Secondary Moderate Mitral Regurgitation after Aortic Valve Replacement —Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17197335 ◽

2020 ◽

Vol 17 (19) ◽

pp. 7335

Author(s):

Ilija Bilbija ◽

Milos Matkovic ◽

Marko Cubrilo ◽

Nemanja Aleksic ◽

Jelena Milin Lazovic ◽

...

Keyword(s):

Aortic Valve ◽

Mitral Regurgitation ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Meta Analysis ◽

Reverse Remodeling ◽

Term Survival ◽

Long Term Survival

Aortic valve replacement for aortic stenosis represents one of the most frequent surgical procedures on heart valves. These patients often have concomitant mitral regurgitation. To reveal whether the moderate mitral regurgitation will improve after aortic valve replacement alone, we performed a systematic review and meta-analysis. We identified 27 studies with 4452 patients that underwent aortic valve replacement for aortic stenosis and had co-existent mitral regurgitation. Primary end point was the impact of aortic valve replacement on the concomitant mitral regurgitation. Secondary end points were the analysis of the left ventricle reverse remodeling and long-term survival. Our results showed that there was significant improvement in mitral regurgitation postoperatively (RR, 1.65; 95% CI 1.36–2.00; p < 0.00001) with the average decrease of 0.46 (WMD; 95% CI 0.35–0.57; p < 0.00001). The effect is more pronounced in the elderly population. Perioperative mortality was higher (p < 0.0001) and long-term survival significantly worse (p < 0.00001) in patients that had moderate/severe mitral regurgitation preoperatively. We conclude that after aortic valve replacement alone there are fair chances but for only slight improvement in concomitant mitral regurgitation. The secondary moderate mitral regurgitation should be addressed at the time of aortic valve replacement. A more conservative approach should be followed for elderly and high-risk patients.

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