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. 2020 Oct;12(10):5869-5878.
doi: 10.21037/jtd-19-3586.

Bioprosthetic or mechanical heart valves: prosthesis choice for borderline patients?-Results from 9,616 cases recorded in Polish national cardiac surgery registry

Krzysztof Bartus  1 , Radosław Litwinowicz  1 , Jerzy Sadowski  1 , Grzegorz Filip  1 , Mariusz Kowalewski  2 , Piotr Suwalski  2 , Piotr Mazur  1 , Anna Kędziora  1 , Marek Jasiński  3 , Marek Deja  4 , Mariusz Kuśmierczyk  5 , Pawel Czub  6 , Michal Zembala  7   8 , Marek Jemielity  9 , Rafał Pawlaczyk  10 , Zdzisław Tobota  11 , Bohdan Maruszewski  11 , Boguslaw Kapelak  1
Affiliations

Bioprosthetic or mechanical heart valves: prosthesis choice for borderline patients?-Results from 9,616 cases recorded in Polish national cardiac surgery registry

Krzysztof Bartus et al. J Thorac Dis. 2020 Oct.

Abstract

Background: In middle-aged patients undergoing aortic valve replacement (AVR), the selection of prosthesis type is a complex process. Current guidelines do not unequivocally indicate the type of prosthesis (bioprosthetic or mechanical) recommended for patients between 60-70 years of age. The aim of the study was to present the trends in AVR prosthesis selection in borderline patients over a 10-year period, based on real-life registry data.

Methods: The study population comprised of 9,616 consecutive patients aged between 60-70 years, who underwent isolated AVR between 2006 and 2016 in all cardiac surgery departments in Poland. Data were extracted from the Polish National Registry of Cardiac Surgery.

Results: Among 27,797 consecutive AVR procedures, patients aged 60-70 years represented 34.6% of the population operated on. From 2006 to 2016, bioprosthetic valves (BVs) were implanted in 53.9% cases, (and) mechanical valves (MVs) in 42.1%. The proportion of different valve types changed in time: from 77.5% of MVs vs. 22.5% of BVs in 2006 to 23.2% of MVs vs. 76.8% of BVs in 2016 (P<0.001). The most commonly implanted BV was the Hancock II (used in 36.4% of BV implantations), the most commonly used MV was the Saint Jude Mechanical prosthesis (implanted in 36.4% of MV implantation cases). A multivariable model identified smaller annulus [OR (95% CI) 0.89 (0.86-0.92), P<0.001], atrial fibrillation [OR (95% CI) 1.32 (1.05-1.67), P=0.017], male sex [OR (95% CI) 1.47 (1.24-1.74), P<0.001] and year of implantation [OR (95% CI) 0.75 (0.71-0.79), P<0.001] as predictors of MV implantation.

Conclusions: Patients aged 60-70 years represent more than one-third of all AVR patients. Between 2006 and 2016, the proportion of implanted prostheses has changed dramatically. In 2016 BVs were implanted in nearly 75% of AVR cases, three times more often than in 2006.

Keywords: Mechanical prosthesis; biological prosthesis; middle-age patients; valve.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-19-3586). MK serves as an unpaid editorial board member of Journal of Thoracic Disease from Sep 2018 to Aug 2020. The other authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Number of cases and mortality of surgical AVR performed in each year.
Figure 2
Figure 2
Type of prosthesis implanted in each year.
Figure 3
Figure 3
Proportion of all implanted prostheses in each year. (A) Biological prosthesis; (B) mechanical prosthesis. *, all type of prosthesis whose frequency <1%.
Figure 4
Figure 4
Multivariate regression model for prosthesis type selection.
See this image and copyright information in PMC

References

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