Influence of coronary artery disease on structural deterioration of porcine bioprostheses
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W W Angell1, D F Pupello, L N Bessone
1St. Joseph's Heart Institute, Tampa, Florida, USA.
Insights
This study found that younger patients (50-69 years) undergoing isolated valve replacement experienced significantly more structural deterioration of porcine bioprosthetic valves compared to those also receiving coronary artery bypass grafting (CABG). Older patients showed no significant difference in valve deterioration rates between groups.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Geriatric Medicine
Background:
- Increasing number of patients require both valve replacement and coronary artery bypass grafting (CABG).
- Porcine bioprosthetic valves are commonly used, but their long-term durability requires evaluation.
- Understanding factors influencing bioprosthetic valve structural deterioration is crucial for patient management.
Purpose of the Study:
- To compare the structural deterioration rates of porcine bioprosthetic valves in patients with isolated valve replacement versus those with concomitant coronary artery bypass grafting (CABG).
- To evaluate the influence of age on bioprosthetic valve structural deterioration in these patient groups.
Main Methods:
- Retrospective comparative analysis of 1,567 patients who underwent valve replacement with porcine xenografts between September 1974 and October 1993.
- Patients were divided into two groups: isolated valve replacement (VR) and valve replacement with CABG (VR + CABG).
- Follow-up data, extending up to 17.9 years, was analyzed for structural deterioration, stratified by age categories.
Main Results:
- Hospital mortality was higher in the VR + CABG group (10.6%) compared to the VR group (7.4%), p=0.0365.
- Significantly greater structural deterioration of porcine valves was observed in the isolated VR group for patients aged 50-59 years (p=0.0121) and 60-69 years (p=0.0230).
- No significant difference in structural deterioration rates was found between the groups for patients aged 70 years and older.
Conclusions:
- Concomitant coronary artery bypass grafting (CABG) may be associated with a reduced rate of structural deterioration in porcine bioprosthetic valves for younger patients (50-69 years).
- Age appears to be a significant factor influencing the differential rates of structural deterioration between isolated valve replacement and combined procedures.
- Further research is warranted to elucidate the mechanisms behind these age-dependent differences in bioprosthetic valve durability.
Abstract:
The number of patients undergoing valve replacement and concomitant coronary artery bypass grafting (CABG) is increasing. To further evaluate the indications for the use of the porcine bioprosthesis, this retrospective comparative analysis of valve structural deterioration was conducted in patients with and without concomitant CABG. From September 1974 to October 1993, 1,567 patients underwent valve replacement using a porcine xenograft. The series was divided into two groups: patients with isolated valve replacement (VR; n = 876) and those with VR and CABG (VR + CABG; n = 691). Aortic valve replacement was performed in 938 patients, mitral valve in 518, tricuspid in 2, and multiple valve replacement in 109 patients. The mean age for the series was 70.7 years (range, 50 to 104 years). The hospital mortality was 8.8% (138 patients). The hospital mortality for the VR group was 7.4% (65 deaths) and the VR + CABG group, 10.6% (73 deaths) p = 0.0365. There were 1,429 patients discharged from the hospital with 1,489 valves at risk. Follow-up extended from 1 month to 17.9 years with a mean of 66.9 months and was 98.3% complete. The cumulative follow-up was 7,927.1 patient-years. Structural deterioration was found to be significantly greater in the VR group for the age category 50 to 59 years (p = 0.0121) and the 60 to 69 years (p = 0.0230). No significant difference in the rate of structural deterioration was found for the two groups for the age category 70 years and older.(ABSTRACT TRUNCATED AT 250 WORDS)
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