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Six years clinical experience with dura mater cardiac valves
Insights
Homologous dura mater bioprostheses show promising long-term results in cardiac valve replacement. These bioprosthetic valves demonstrated favorable survival rates and significant functional improvement without anticoagulation.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Outcomes Research
Background:
- Homologous dura mater bioprostheses have been utilized for cardiac valve replacement.
- A significant number of patients (217) have received these implants over a 6-year period.
- Previous studies indicate varied outcomes with different prosthetic materials.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of homologous dura mater bioprostheses in cardiac valve replacement.
- To assess early and late mortality, functional status improvement, and thromboembolic events.
- To compare outcomes with existing prosthetic valves.
Main Methods:
- Retrospective analysis of 217 patients undergoing cardiac valve replacement using homologous dura mater bioprostheses.
- Focus on isolated mitral (151 patients) and aortic (29 patients) valve replacements.
- Data collection included mortality rates, New York Heart Association (NYHA) class, and thromboembolic complications.
Main Results:
- Early mortality was 10.5% for mitral and 13.8% for aortic replacements, primarily due to myocardial failure.
- Late mortality was 7.3% (mitral) and 12.0% (aortic).
- Significant NYHA class improvement observed (mitral: 3.76 to 1.13; aortic: 3.64 to 1.32). Actuarial survival at 6 years was 87% (mitral) and 84% (aortic). Crucially, no thromboembolic events occurred without anticoagulation.
Conclusions:
- Homologous dura mater bioprostheses offer favorable 6-year survival rates comparable to other prostheses.
- These bioprostheses lead to substantial functional improvement in patients with valvular heart disease.
- The absence of thromboembolic events without anticoagulation highlights a significant safety advantage.
Abstract:
Homologous dura mater bioprostheses have been used for over 6 years in 217 patients who hae undergone cardiac valve replacement at Chulalongkorn Hospital and Medical School, Bangkok. The mitral valves were replaced in 151 patients (69.6%), aortic valve replacements were performed in 29 patients (13.7%), and multiple valve replacement were performed in 37 patients (16.7%). This study will be confined mainly to the isolated mitral and aortic valve replacements. The early deaths in the mitral replacement series was 10.5%, and 13.8% in the aortic valve replacement. Myocardial (pump) failure was the cause of early death in the majority of cases. The late mortality was 7.3% in the mitral position and 12.0% in the aortic position. The mean improvement of NYHA class was from 3.76 to 1.13 in the mitral series, and from 3.64 to 1.32 in the aortic group. The actuarial survival rates at 6 years after operation were 87% and 84% respectively and compare favorably with several prostheses currently in use. There was no case of thromboembolism even though no anticoagulants were used.