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[Comparison of the long-term results of intra or extracardiac implanted bioprosthetic valves]
Insights
Intracardiac bioprosthetic valves show superior long-term results compared to extracardiac ones, with significantly lower reoperation rates due to dysfunction. This highlights the importance of valve placement in cardiac surgery outcomes.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Medical Device Engineering
Background:
- Bioprosthetic valves are crucial in cardiac repair, but long-term outcomes vary based on implantation site.
- Intracardiac and extracardiac implantation strategies present different challenges and success rates.
Purpose of the Study:
- To compare the long-term efficacy and durability of intra- vs. extracardiac implanted bioprosthetic valves.
- To identify failure modes and reoperation rates associated with each implantation type.
Main Methods:
- Retrospective analysis of 41 adult patients with intra/extracardiac valves (mitral, aortic, tricuspid).
- Analysis of 25 pediatric patients undergoing right ventricular-pulmonary artery conduit repair.
- Comparison of reoperation-free survival rates and causes of prosthetic valve dysfunction.
Main Results:
- Intracardiac valves had significantly higher reoperation-free survival at 7 (91%) and 9 (82%) years versus extracardiac valves (51% and 8.6%, respectively).
- Prosthetic valve dysfunction in extracardiac cases was mainly stenosis (fusion/calcification).
- Regurgitation due to tear/perforation was more common with intracardiac valves.
Conclusions:
- Intracardiac bioprosthetic valve implantation demonstrates superior long-term outcomes and durability compared to extracardiac placement.
- Understanding failure mechanisms is critical for improving bioprosthetic valve design and surgical techniques.
Abstract:
The long-term results following intra or extracardiac implanted bioprosthetic valves were compared. Forty-one patients, whose average age at the operation was 43.3 +/- 10.7 (mean +/- SD) year-old, were implanted 33 Hancock and 11 Carpentier-Edwards porcine valves, 35 in mitral, 6 in aortic and 3 in tricuspid position. Twenty-five children, whose average age was 6.0 +/- 3.5 year-old (p < 0.01) at the operation, underwent right ventricular-pulmonary artery conduit repair with 16 Hancock, 7 Carpentier-Edwards porcine valves and 2 Ionescu-Shiley pericardial valves. There were only one late death and one operative death in the patients implanted intracardiac bioprosthetic valves. Seven intracardiac and 12 extracardiac implanted bioprosthetic valves were removed at the reoperation for prosthetic valve dysfunction. The probabilities free from reoperation after 7 and 9 years of follow-up was 91% and 82%, respectively, with intracardiac implanted valves, on the other hand 51% (p < 0.05) and 8.6% (p < 0.05), respectively, with extracardiac implanted valves. Valve dysfunction in extracardiac implantation was mainly related to the stenosis due to fusion of comissure and/or calcification. Regurgitation due to tear and/or perforation was mainly associated with intracardiac implanted bioprosthetic valves.