Medtronic Freestyle aortic bioprosthesis: a potential option for haemodialysis patients.
Interact Cardiovasc Thorac Surg
; 22(4): 459-63; discussion 463-4, 2016 Apr.
Article
em En
| MEDLINE
| ID: mdl-26792359
ABSTRACT
OBJECTIVES:
End-stage renal disease patients on regular haemodialysis are at higher risk of calcification. Therefore, many surgeons have concerns regarding the implantation of bioprostheses in such patients. The haemodynamic advantages of stentless aortic bioprostheses support their use; however, these have not been studied yet in end-stage renal disease patients. We studied accordingly the early and mid-term outcomes of aortic valve replacement (AVR) using Medtronic Freestyle stentless aortic bioprostheses in this subset of patients in comparison with stented aortic bioprostheses.METHODS:
We retrospectively studied two groups of consecutive patients on regular haemodialysis who required AVR between 2007 and 2013. Non-Freestyle (NFS) group received stented aortic bioprostheses (36 patients) and Freestyle (FS) group received Medtronic Freestyle aortic bioprostheses (48 patients). Follow-up ranged from 2 to 76 months with a mean follow-up of 36.3 ± 25 months.RESULTS:
Patients in both groups showed similar demographic characters regarding age (76.4 ± 8.1 vs 74.9 ± 7.2 years; P = 0.35), male gender (58 vs 60%; P = 0.57) and diabetes mellitus (42 vs 48%; P = 0.57). Smaller aortic bioprostheses were implanted in the NFS (23.3 ± 1.2 vs 25.4 ± 2.1; P < 0.001) with consequently higher postoperative mean gradients (14.1 ± 4.1 vs 11.9 ± 5.3 mmHg; P = 0.004). No significant differences were noted regarding postoperative neurological disorder (8 vs 12%; P = 0.73), deep sternal wound infection (3 vs 4%; P = 0.68), re-exploration (8 vs 8%; P = 0.91) and in-hospital mortality (6 vs 4%; P = 0.92). Mid-term follow-up showed higher prosthetic valve calcification and/or sclerosis in NFS group (25 vs 6%; P = 0.015), whereas no significant differences were noticed between the two groups regarding stroke (0 vs 8%; P = 0.13), endocarditis (0 vs 4%; P = 0.50), 36- and 72-month survival (51 ± 2%, 14 ± 4% vs 55 ± 2%, 19 ± 3%, respectively; P = 0.45).CONCLUSIONS:
Aortic bioprostheses are a good option for haemodialysis patients requiring AVR, offering acceptable mid-term survival. The Medtronic Freestyle aortic bioprostheses could allow the implantation of larger bioprostheses inferring consequently lower mean gradients, with a potentially higher resistance to calcification and sclerosis in haemodialysis patients.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Valva Aórtica
/
Insuficiência da Valva Aórtica
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Estenose da Valva Aórtica
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Bioprótese
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Próteses Valvulares Cardíacas
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Stents
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Diálise Renal
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Implante de Prótese de Valva Cardíaca
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Endocardite
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Falência Renal Crônica
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Observational_studies
Limite:
Aged
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Aged80
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Interact Cardiovasc Thorac Surg
Assunto da revista:
ANGIOLOGIA
/
CARDIOLOGIA
Ano de publicação:
2016
Tipo de documento:
Article
País de afiliação:
Egito