Late clinical outcomes after mechanical aortic valve replacement for aortic stenosis: old versus new prostheses.

Lee, Heemoon; Sung, Kiick; Kim, Wook Sung; Jeong, Dong Seop; Ahn, Joong Hyun; Carriere, Keumhee Chough; Park, Pyo Won
Journal of thoracic disease
2018Jun ; 10 ( 6 ) :3361-3371.
저자 상세정보
Lee, Heemoon -
Sung, Kiick -
Kim, Wook Sung -
Jeong, Dong Seop -
Ahn, Joong Hyun -
Carriere, Keumhee Chough -
Park, Pyo Won -
BACKGROUND: The study aimed to evaluate the late clinical outcomes of new-generation mechanical valves for severe aortic stenosis (AS) compared with old mechanical valves.

METHODS: We retrospectively reviewed data from 254 patients with severe AS, who underwent primary mechanical aortic valve replacement from 1995 to 2013. Patients were classified into two groups: old-valve group (n=65: 33 ATS standard, 32 Medtronic-Hall) and new-valve group (n=189: 113 St. Jude Regent, 46 On-X, 30 Sorin Overline). Median patient age was 58 years (Q1-Q3: 52-61). With propensity score matching based on demographic information, 56 patients in the old-valve group were matched with 177 patients in the new-valve group. The median follow-up duration was 91 months (Q1-Q3: 48-138).

RESULTS: Cardiac-related mortality and hemorrhagic events were significantly lower in the new-valve group (P=0.047 and P=0.032, respectively). The median international normalized ratio (INR) at follow-up was significantly higher in the old-valve group [2.23, Q1-Q3: 2.14-2.35 (old-valve group); 2.08, Q1-Q3: 1.92-2.23 (new-valve group), P<0.001]. The incidence of prosthesis-patient mismatch (PPM) was significantly higher in the old-valve group (P<0.001). Multivariate analysis of the total population revealed that PPM was a significant risk factor for cardiac-related events [hazard ratio (HR) =5.279, 95% CI, 1.886-14.561, P=0.002] and showed higher trend of increasing mortality (HR =3.082, P=0.076).

CONCLUSIONS: New mechanical prostheses showed a better hemodynamic performance and lower incidence of PPM. Anticoagulation strategy to lower the target INR in patients with new mechanical valves may improve late outcomes by reducing hemorrhagic events.
Aortic valve replacement; anticoagulation; mechanical valve; prosthesis-patient mismatch (PPM)

주제명(Target field)
연구참여(Sample size)
질병특성(Condition Category)
연구설계(Study Design)
중재방법(Intervention Type)
중재명칭(Intervention Name)
New mechanical prostheses showed a better hemodynamic performance and lower incidence of PPM.
연구비지원(Fund Source)
근거수준평가(Evidence Hierarchy)
ICD 03