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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Biological versus mechanical aortic prosthesis? A nineteen-year comparison in a propensity-matched population
Tomaso Bottio1, Giulio Rizzoli, Luca Caprili
1Department of Cardiovascular Surgery, University of Padua Medical School, Padua, Italy. tomaso.bottio@unipd.it
The Journal of Heart Valve Disease
|August 25, 2005
Summary
The Sorin valve demonstrated fewer complications than the Hancock Standard valve in younger patients undergoing aortic valve replacement (AVR). When accounting for risk factors, both valves showed similar long-term outcomes, suggesting valve choice may be less critical than patient factors.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Outcomes Research
Background:
- Aortic valve replacement (AVR) choices between mechanical and tissue valves are debated due to varying complication rates.
- Malfunction and systemic complications impact outcomes for both mechanical and tissue aortic valve substitutes.
- This study compares the Sorin Monocast (tilting disk) and Hancock Standard (tissue) valves to assess their influence on AVR outcomes.
Purpose of the Study:
- To determine if the valve model (Sorin vs. Hancock Standard) is a marker or a causal factor in poor outcomes after aortic valve replacement (AVR).
- To investigate the impact of biological versus mechanical valve models on patient survival and complications post-AVR.
- To evaluate long-term valve-related complications and overall survival for two distinct aortic valve prostheses.
Main Methods:
- A cohort of 379 patients under 70 years old receiving either Sorin (n=213) or Hancock Standard (n=192) valves between 1970-1984.
- Long-term follow-up (2,471 pt-yr for Sorin, 2,368 pt-yr for Hancock) with 98% completeness.
- Propensity score matching was employed to control for patient and operative risk factors, analyzing outcomes by 'intention to treat'.
Main Results:
- No significant difference in 30-day mortality (7.5% Sorin vs. 10.9% Hancock) or 19-year valve-related mortality (84% Sorin vs. 82% Hancock).
- Significantly higher 19-year freedom from valve-related complications for Sorin (43%) compared to Hancock (19%), primarily due to structural valve deterioration (SVD) in the Hancock group.
- After propensity score matching, excluding SVD and reoperations, survival and complication rates were similar between the two valve types.
Conclusions:
- The Sorin valve exhibited a lower rate of valve-related complications compared to the Hancock Standard valve in this younger patient cohort.
- The Hancock Standard valve showed an increasing rate of reoperation due to SVD, indicating potential inadequacy for younger patients.
- When analyzed by 'intention to treat' and propensity score, long-term survival and complication rates were comparable, suggesting patient risk factors heavily influence outcomes.
