Midterm results after St Jude Medical Epic porcine xenograft for aortic, mitral, and double valve replacement.
EuroSCORE II
active endocarditis
porcine xenograft
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
pubmed:
1
7
2020
medline:
11
8
2020
entrez:
30
6
2020
Statut:
ppublish
Résumé
The aim of this study was to evaluate the results after stented porcine xenograft implantation (Epic, SJM, St Paul, MN) with Linx anticalcification treatment in elderly patients at our high-volume tertiary care center. A total of 3825 patients undergoing aortic (AVR = 2441), mitral (MVR = 892), or double valve (DVR = 492) replacement between 11/2001 and 12/2017 with Epic xenografts were evaluated. Outcomes were assessed by reviewing the prospectively acquired hospital database results, and regular annual follow-up information was acquired from questionnaires or telephone interviews. For patients undergoing AVR, MVR, DVR, age at surgery were 76.4 ± 6, 71.2 ± 9, 72.9 ± 8 years; active endocarditis was an indication for valve surgery in 4.5%, 20.7%, 19.7%; and the predicted median (interquartile range [IQR]) mortality risk (EuroSCORE II) was 5.2% (3.1%-9.4%), 7.5% (3.9%-16.2%), 9.9% (6.0%-19.6%), respectively. Median follow-up was 3.04 (IQR: 0.18-5.21). Thirty-day survival was 91.2% ± 0.6%, 87.6% ± 0.1.1%, 84.7% ± 1.6%; and 10-year survival was 56.7% ± 1.0%, 59.4% ± 2.5%, 50.45% ± 3.1%, respectively. Patients who underwent MVR versus AVR were at significant increased risk for reoperation for endocarditis (adjusted odds ratio; 2.2, 95% confidence interval; 1.29-3.7; P = .003). There was no significant difference in all-cause mortality at midterm in AVR vs MVR in the matched cohort (P = .85). Implantation of the Epic stented porcine xenograft is associated with acceptable survival and freedom from valve-related complications or reoperation due to structural valve disease at midterm follow-up.
Sections du résumé
BACKGROUND
BACKGROUND
The aim of this study was to evaluate the results after stented porcine xenograft implantation (Epic, SJM, St Paul, MN) with Linx anticalcification treatment in elderly patients at our high-volume tertiary care center.
METHODS
METHODS
A total of 3825 patients undergoing aortic (AVR = 2441), mitral (MVR = 892), or double valve (DVR = 492) replacement between 11/2001 and 12/2017 with Epic xenografts were evaluated. Outcomes were assessed by reviewing the prospectively acquired hospital database results, and regular annual follow-up information was acquired from questionnaires or telephone interviews.
RESULTS
RESULTS
For patients undergoing AVR, MVR, DVR, age at surgery were 76.4 ± 6, 71.2 ± 9, 72.9 ± 8 years; active endocarditis was an indication for valve surgery in 4.5%, 20.7%, 19.7%; and the predicted median (interquartile range [IQR]) mortality risk (EuroSCORE II) was 5.2% (3.1%-9.4%), 7.5% (3.9%-16.2%), 9.9% (6.0%-19.6%), respectively. Median follow-up was 3.04 (IQR: 0.18-5.21). Thirty-day survival was 91.2% ± 0.6%, 87.6% ± 0.1.1%, 84.7% ± 1.6%; and 10-year survival was 56.7% ± 1.0%, 59.4% ± 2.5%, 50.45% ± 3.1%, respectively. Patients who underwent MVR versus AVR were at significant increased risk for reoperation for endocarditis (adjusted odds ratio; 2.2, 95% confidence interval; 1.29-3.7; P = .003). There was no significant difference in all-cause mortality at midterm in AVR vs MVR in the matched cohort (P = .85).
CONCLUSIONS
CONCLUSIONS
Implantation of the Epic stented porcine xenograft is associated with acceptable survival and freedom from valve-related complications or reoperation due to structural valve disease at midterm follow-up.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1769-1777Informations de copyright
© 2020 Wiley Periodicals, Inc.
Références
Lehmann S, Merk DR, Etz CD, et al. Porcine xenograft for aortic, mitral and double valve replacement: long-term results of 2544 consecutive patients. Eur J Cardiothorac Surg. 2016;49:1150-1156.
Lehmann S, Meyer A, Schroeter T, et al. Midterm durability and hemodynamic performance of a third-generation bovine pericardial prosthetic aortic valve: the Leipzig experience. Ann Thorac Surg. 2017;103:1933-1939.
Binet JP, Duran CG, Carpentier A, Langlois J. Heterologous aortic valve transplantation. Lancet. 1965;286:1275.
Baumgartner H, Falk V, Bax JJ, et al. ESC/EACTS guidelines for the management of valvular heart disease. Euro Heart J. 2017;2017(38):2739-2791.
Isaacs AJ, Shuhaiber J, Salemi A, Isom OW, Sedrakyan A. National trends in utilization and in-hospital outcomes of mechanical versus bioprosthetic aortic valve replacements. J Thorac Cardiovasc Surg. 2015;149:1262-1269.
Borger MA, Ivanov J, Armstrong S, Christie-Hrybinsky D, Feindel CM, David TE. Twenty-year results of the Hancock II bioprosthesis. J Heart Valve Dis. 2006;15:49-56.
Banbury MK, Cosgrove DM III, White JA, Blackstone EH, Frater RW, Okies JE. Age and valve size effect on the long-term durability of the Carpentier-Edwards aortic pericardial bioprosthesis. Ann Thorac Surg. 2001;72:753-757.
Bourguignon T, Bouquiaux-Stablo AL, Candolfi P, et al. Very long-term outcomes of the Carpentier-Edwards Perimount valve in aortic position. Ann Thorac Surg. 2015;99:831-837.
David TE, Armstrong S, Sun Z. The Hancock II bioprosthesis at ten years. Ann Thorac Surg. 1995;60:S229-S234.
Wang Y, Chen S, Hu XJ, Shi JW, Dong NG. Mid-to long-term clinical outcomes of Hancock II bioprosthesis in Chinese population. Chin Medical J. 2015;128:3317-3323.
Masters RG, Haddad M, Pipe AL, Veinot JP, Mesana T. Clinical outcomes with the Hancock II bioprosthetic valve. Ann Thorac Surg. 2004;78:832-836.
Ius F, Schulz J, Roumieh M, et al. Long-term results of the Mitroflow aortic pericardial bioprosthesis in over 800 patients: limited durability and mechanisms of dysfunction. Euro J Cardiothorac Surg. 2017;52:264-271.
Akins CW, Miller DC, Turina MI, et al. Guidelines for reporting mortality and morbidity after cardiac valve interventions. Euro J Cardiothorac Surg. 2008;33:523-528.
Dvir D, Eltchaninoff H, Ye J, et al. First look at long-term durability of transcatheter heart valves: assessment of valve function up to 10 years after implantation. EuroPCR, Paris. 2016.
Bourguignon T, El Khoury R, Candolfi P, et al. Very long-term outcomes of the Carpentier-Edwards Perimount aortic valve in patients aged 60 or younger. Annal Thorac Surg. 2015;100:853-859.
Deeb GM, Chetcuti SJ, Reardon MJ, et al. 1-year results in patients undergoing transcatheter aortic valve replacement with failed surgical bioprostheses. JACC: Cardiovasc Int. 2017;10:1034-1044.
David TE, Gavra G, Feindel CM, Regesta T, Armstrong S, Maganti MD. Surgical treatment of active infective endocarditis: a continued challenge. J Thorac Cardiovasc Surg. 2007;133:144-149.