Liệu van sinh học có thay thế hoàn toàn van cơ học

Do Mechanical Valves Replace Totally the Tissue Valve Prosthesis Michael S Firstenberg, MD FACC Assistant Professor of Surgery Northeast Ohio Medical University Cardiothoracic Surgery Akron City Hospital - The Summa Health System No conflicts related to this presentation The Burden of Valve Disease • 2007 US/STS: 17,592 AVR – – • 14,957 AVR+CABG 5% of ‘elderly’ patients have aortic stenosis and might benefit from AVR Current guidelines: – Tissue valves for ‘elderly’ (>70 years/old) and those with a predicted life span 5,800 pts Pericardial: studies, >2,900 pts Years post implant J Am Coll Cardiol 2010;55(22):2413-2426 • Younger patients develop earlier SVD • More likely to require early reoperation – More likely to tolerate the complications of valve dysfunction Actuarial Freedom from SVD (%) Structural Valve Deterioration at 10-15 years – More likely to survive their operation • Limited studies on biologic valves in younger patients Age at time of implant (years) J Am Coll Cardiol 2010;55(22):2413-2426 Mechanical: Bleeding Biologic: •Younger patients: •Might tolerated complications better •Re-operative is not benign! >20% mortality when over 80 years/old Mechanical Risk of Re-operation and Major Bleeding (%) •Older patients: •More likely to have bleeding complications (which can be fatal) •Less likely to be considered for re-op Re-operation Biological Age at valve implant J Am Coll Cardiol 2010;55(22):2413-2426 2000 vs 1977 – 1982, 575 men •AVR: 394 •MVR: 181 •Randomized in the OR: •Bjork-Shiley tilting disc mechanical •Hancock porcine bioprosthetic •Operative Mortality: 7.7% •Similar for both groups •End-points: •15 year mortality and valve-related complications Bleeding Complications 15 Year Follow-up VA Study Aortic Valve Mitral Valve Biologic (30 ± 4%) Mechanical (51 ± 4%) P