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Bioprosthetic Aortic Valve Replacement In Patients At Increased Risk Of Early Structural Valve Degeneration
Alfredo Giuseppe Cerillo, Anna Rita Manca, Iorgos Paduvakis, Francesca Petrini, Luisa Iannone, Giorgia Giustini, Lorenzo Terzano, Pierluigi Stefano;
Careggi University Hospital, Florence, Italy
BACKGROUND: Biological prostheses have increasingly been used in young patients to avoid anticoagulation. The newest aortic bioprosthesis with anticalcification treatment and dry storage, are extremely promising in this population, since it has shown reduced calcification of the prosthetic leaflets in preclinical and early clinical studies. Little data are available, however, in patients younger than 65. This study investigates the hemodynamic performance and clinical outcome of these new bioprosthesis in a group of patients at increased risk of early structural valve degeneration (SVD).
METHODS: From January 2018, 342 patients aged 56 ± 10.7 years underwent AVR with anticalcification-treated bioprosthesis at our institution. Ninety-two patients were younger than 50, and 24 had chronic renal failure. A minimally invasive approach was used in all isolated AVR patients. Associated procedures were performed in 157 (45.9%) patients (56 redo).
RESULTS: 11 patients died (3.2%), with one in-hospital death. Major complications included bleeding (32), respiratory failure (20) and BAV requiring PMK (7). Nine patients (2.6%) needed reoperation during the follow-up, one for other valve procedure, six for prosthetic valve endocarditis, and two for prosthesis degeneration. One valve thrombosis was observed, successfully treated with systemic anticoagulation; no thromboembolic events were observed. Furthermore, a transient increase of the transprosthetic gradient, in the range of subclinical SVD, was observed in only 3 patients (0.8%). At medium follow up of 34.12 +/- 16.06 months, all except four patients reported a significant improvement of their symptomatic status (98.8 % were in NYHA ≤ II) and quality of life.Survival from rehospitalization for surgical-related causes rate was 95.4% and overall survival rate was 96.8%. Survival from rehospitalization for all causes rate was 84.2%.
CONCLUSIONS: Our study demonstrates excellent early hemodynamics and promising results at up to five years in a cohort of very young patients. Further studies with longer follow-up are needed.
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