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Published on: May 21, 2017
Long-term outcome after valve replacement with the omnicarbon prosthesis
Michele di Summa1, Giuseppe Poletti, Lidia Brero
1Department of Cardiac Surgery, University Hospital of Turin, Italy.
Insights
Long-term prognosis after Omnicarbon valve replacement shows good survival and quality of life. This tilting-disc prosthesis offers reliable service with low complication rates for patients undergoing aortic (AVR), mitral (MVR), or double valve replacement (DVR).
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Outcomes Research
Background:
- Assessing long-term prognosis after prosthetic valve replacement is crucial for patient management.
- The Omnicarbon tilting-disc prosthesis is a specific type of artificial heart valve used in surgical procedures.
- Rheumatic valvular pathology is a common indication for valve replacement surgery.
Purpose of the Study:
- To evaluate the long-term prognosis of patients who received valve replacement with the Omnicarbon tilting-disc prosthesis.
- To determine the impact of this specific prosthesis on survival and quality of life.
- To assess valve-related complications and functional capacity post-implantation.
Main Methods:
- Prospective data collection for 153 valve replacement cases using the Omnicarbon prosthesis (February 1985 - January 1986).
- Detailed recording of surgical data, including type of valve replacement (aortic, mitral, double).
- Comprehensive follow-up of 151 patients (99% completion rate) for up to 14 years.
Main Results:
- 10-year survival was 68%, falling to 57% at 14 years, with specific rates for aortic (AVR), mitral (MVR), and double valve replacement (DVR).
- Low rates of thromboembolic (91-94% freedom at 10-14 years) and hemorrhagic events were observed.
- Excellent functional outcomes with 95% of patients in NYHA class I or II at follow-up, indicating sustained improvement in quality of life.
Conclusions:
- The Omnicarbon tilting-disc valve demonstrates reliable and satisfactory long-term performance.
- Patient survival and quality of life outcomes exceeded expectations following implantation.
- Low rates of valve-related complications and sustained functional improvement support the use of this prosthesis.
Background And Aim Of The Study:
The study aim was to determine whether long-term prognosis was affected by valve replacement with a tilting-disc prosthesis.
Methods:
Surgical data were recorded prospectively for all (n = 153) valve replacement cases with the Omnicarbon prosthesis during the period February 1985 to January 1986. A rheumatic valvular pathology was present in 105 patients (68.6%). There were 78 (51%) aortic (AVR), 51 (33%) mitral (MVR) and 24 (16%) double (DVR) valve replacements. The follow up was 99% complete (n = 151).
Results:
Mean follow up was 10.2+/-4.4 years (total 1,472 patient-years (pt-yr)). Survival at 10 years was 68+/-4% (71+/-5% AVR, 61+/-7% MVR), and this fell to 57+/-4% at 14 years. No structural failure was observed. Thromboembolic and hemorrhagic events were rare, with actuarial freedom from thromboembolism of 94+/-2% and 91+/-3% at 10 and 14 years, respectively. This low incidence of thromboembolism encouraged an ease in anticoagulation; hence the AVR and MVR cohorts had a median INR of 2.8, but a higher INR (3.4) was maintained in DVR patients. All prostheses had acceptable hemodynamic performance. No cases of hemolytic anemia were detected, and mean blood counts were within normal ranges. Lactate dehydrogenase values indicated minimal hemolysis, and were lowest after AVR (median LDH 93% normal) and highest after DVR (median LDH 136% normal). Functional evaluation showed an improvement in NYHA class that remained stable over 14 years. At follow up, 95% (75/79) of patients were in NYHA class I or II.
Conclusion:
Survival and quality of life after Omnicarbon valve implantation exceeded the authors' expectations. Functional capacity remains good, and valve-related complication rates are low. The Omnicarbon tilting-disc valve has been shown to provide reliable and satisfactory service in the long term.
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