Troca valvar aórtica com diferentes próteses: existem diferenças nos resultados da fase hospitalar?

Abstract

Objective: To analyze intraoperative data and possible differences in clinical evolution during postoperative hospital phase for aortic valve replacement surgery using different types of prosthesis.Methods: Analysis of 60 patients divided into three groups. Valve replacement with bioprosthesis (20), mechanical prosthesis (20) and homologous valve (20). The mean age was 51.1, 60% were male and 40% female patients; 86.7 % were in NYHA II or III; 63.3% presented arterial hypertension and 18.3% had diabetes. Aetiology of valve disease was degenerative for 39%, rheumatic for 36% and endocardits for 15%.Results: The hospital mortality was 5%; there were no differences in the incidence of septical or cardiogenic shock, acute renal failure, rhythms disorders during surgery or intensive care, neither for total time in intensive care and mechanical ventilation. However, there was statistical differences as regards the cardiopulmonary bypass total time (P=0.02) and the aortic clamping time (P<0.0001) unfavorable to homograft valve group. The ward admission time was greater for mechanical valve group (P=0.05) as well as for total admission time, but without statistical significance. It was observed that patients with preoperative hematocrit smaller than 38.1% used 2.73 units of blood components, and with postoperative hematocrit smaller than 32% used 1,79 units of blood components. Echocardiography control showed minimal evolutional differences. Conclusion 535FEGURI, GR ET AL -Aortic valve replacement with different types of prosthesis. Are there differences in the outcomes during hospital phase? Bras Cir Cardiovasc 2008; 23(4): 534-541 Rev

Risk factors for hospital mortality in valve replacement with porcine bioprosthesis at an universitary institution

“…It is possible that several demographic characteristics determine the difference in mortality, taking into account the mean age of patients referred for mechanical prostheses implantation and bioprostheses implantation, higher in the latter group (46.8 years and 66.5 years, respectively). Studies comparing results with implantation of a bioprosthesis or mechanical prosthesis in populations with overlapping patients as clinical characteristics, similar to that performed by Feguri et al [30] can determine whether the observed differences in relation to mortality and risk factors are due to the type of valve replacement or to several characteristics of populations with indications for different cardiac valves.…”

Valvular Disorders in Carcinoid Heart Disease

“…Contrary to conventional guidelines of heart valve operation and choices of heart valve prosthesis [26,27] , most surgeons prefer bioprostheses in the tricuspid position because of the lower propensity to thrombosis in carcinoid heart disease. However, questions have been raised about the long-term durability of porcine valves exposed to the metabolic products of carcinoid tumors.…”

Resultados de pacientes submetidos à cirurgia de substituição valvar aórtica usando próteses mecânicas ou biológicas

“…This is because there is no ideal substitute to provide a long life, without the use of oral anticoagulants, with no increased risk of thromboembolism and operating mechanism similar to the native valve [8][9][10][11][12][13][14]. Still, the clinical decision becomes increasingly challenging with the increase in life expectancy and the presence of comorbidities such as advanced age, congestive heart failure, coronary artery disease, pulmonary disease and renal failure [6].…”