Original article: cardiovascularResults of bioprosthetic versus mechanical aortic valve replacement performed with concomitant coronary artery bypass grafting☆
Section snippets
Patients
A computerized registry of cardiac surgical patients at the Massachusetts General Hospital was used to identify 750 consecutive patients having combined aortic valve replacement and coronary artery bypass grafting from January 1984 through July 1997. Because the principal focus of the study was the long-term consequences of prosthesis selection, the study was closed at that time to allow a follow-up period of at least 2 postoperative years for every patient in the study. Records of 750
Results
Some important demographic and clinical risk factors are listed in Table 1. Bioprosthetic valve recipients were significantly older, had smaller body surface areas, and more peripheral vascular disease.
The 469 bioprostheses implanted in this study included 341 Carpentier-Edwards porcine and 128 Carpentier-Edwards pericardial valves. The 281 mechanical valves implanted in this study included 168 St. Jude Medical, 56 Medtronic-Hall, 45 Starr-Edwards, 11 Bjork-Shiley, and one CarboMedics valves.
Comment
Several published studies have compared the long-term results of the decision to insert a bioprosthetic or mechanical valve in patients who require aortic valve replacement 1, 2, 3, 4, 5, 6, but most of the patients in those studies had isolated valve replacement. Other studies have documented the deleterious impact on late survival of concomitant coronary artery bypass grafting when required in conjunction with aortic valve replacement 7, 8, 9, 10. In 1994, Jones and colleagues documented the
Acknowledgements
This study was supported by a grant from the John F. Welch/GE Fund for Cardiac Surgical Research. The authors wish to acknowledge the assistance of Barbara J. Akins, BSN, and Annetta L. Boisselle, BSN, for their help in data acquisition and management; John B. Newell, former director of the Cardiac Computer Center, Massachusetts General Hospital, for his assistance in the statistical evaluations; and Jerene M. Bitondo, PA-C, for her help with manuscript preparation.
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Mechanical Versus Bioprosthetic Aortic Valve Replacement in Patients Aged 50 Years and Younger
2018, Annals of Thoracic SurgeryCitation Excerpt :Finally, the type of prosthesis was not a predictor for all-cause mortality in our Cox regression model. Major bleeding events with mAVR are of increasing concern to most clinicians and patients and an important determinant of valve choice among young patients, especially given their lifestyle and lifetime risk of anticoagulation-related complications [14–17]. These complications can lead to lower physical capacity, a higher prevalence of disability, and poorer disease perception [18].
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Dr Akins discloses that he has a financial relationship with Medtronic, Inc.