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Resultados de pacientes submetidos à cirurgia de substituição valvar aórtica usando próteses mecânicas ou biológicas / Outcomes of patients subjected to aortic valve replacement surgery using mechanical or biological prostheses
Almeida, Adriana Silveira de; Picon, Paulo Dornelles; Wender, Orlando Carlos Belmonte.
  • Almeida, Adriana Silveira de; Grupo Hospitalar Conceição. Hospital Nossa Senhora da Conceição. Serviço de Cirurgia Cardiovascular. Porto Alegre. BR
  • Picon, Paulo Dornelles; UFRGS. Faculdade de Medicina. Departamento de Medicina Interna. Porto Alegre. BR
  • Wender, Orlando Carlos Belmonte; UFRGS. Faculdade de Medicina. Departamento de Cirurgia.
Rev. bras. cir. cardiovasc ; 26(3): 326-337, jul.-set. 2011.
Article in Portuguese | LILACS | ID: lil-624513
RESUMO

OBJETIVO:

Esse estudo avalia resultados em pacientes submetidos à cirurgia para troca valvar aórtica utilizando substituto biológico ou mecânico, com poder de relevância na seleção do tipo da prótese.

MÉTODOS:

Foram selecionados, randomicamente, 301 pacientes submetidos à cirurgia para troca valvar aórtica entre 1990 e 2005, com seguimento máximo de 20 anos.

RESULTADOS:

Sobrevivência em 5, 10 e 15 anos após cirurgia utilizando substituto mecânico foi de 83,9%, 75,4% e 60,2% e, para substituto biológico, foi de 89,3%, 70,4% e 58,4%, respectivamente (P=0,939). Fatores associados com óbito foram idade, obesidade, doença pulmonar, arritmias, eventos hemorrágicos e insuficiência valvar aórtica. Probabilidade livre de reoperação desses pacientes em 5, 10 e 15 anos após cirurgia utilizando substituto mecânico foi de 97,9%, 95,8% e 95,8% e, para bioprótese, foi de 94,6%, 91,0% e 83,3%, respectivamente (P=0,057). Fatores associados com reoperação foram insuficiência renal, endocardite de prótese e idade. Probabilidade livre de eventos hemorrágicos em 5, 10 e 15 anos após cirurgia utilizando substituto mecânico foi de 94,5%, 91,7% e 91,7% e, para bioprótese, foi de 98,6%, 97,8% e 97,8%, respectivamente (P=0,047). Fatores associados com eventos hemorrágicos foram insuficiência renal e prótese mecânica.

CONCLUSÕES:

Os autores concluíram que 1) mortalidade foi estatisticamente semelhante entre os grupos; 2) características basais dos pacientes foram os maiores determinantes de mortalidade tardia após a cirurgia; 3) houve tendência à reoperação para o grupo com bioprótese; 4) pacientes com prótese mecânica tiveram mais eventos hemorrágicos ao longo do tempo; 5) dados encontrados no presente estudo são concordantes com a literatura atual.
ABSTRACT

OBJECTIVE:

This paper evaluates outcomes in patients subjected to surgery for replacement of the aortic valve using biological or mechanical substitutes, where selection of the type of prosthesis is relevant.

METHODS:

Three hundred and one patients, randomly selected, who had been subjected to aortic valve replacement surgery between 1990 and 2005, with a maximum follow-up period of 20 years.

RESULTS:

Survival at 5, 10 and 15 years after surgery using mechanical substitute was 83.9%, 75.4% and 60.2% and, for biological substitute, was 89.3%, 70.4% and 58.4%, respectively (P=0.939). Factors associated with death were age, obesity, pulmonary disease, arrhythmia, bleeding and aortic valve failure. Probability free of reoperation for these patients at 5, 10 and 15 years after surgery using mechanical substitute was 97.9%, 95.8% and 95.8% and, for those using bioprostheses, was 94.6%, 91.0% and 83.3%, respectively (P=0.057). Factors associated with reoperation were renal failure, prosthesis endocarditis and age. Probability free of bleeding events at 5, 10 and 15 years after surgery using mechanical substitute was 94.5%, 91.7% and 91.7% and, for bioprostheses, was 98.6%, 97.8% and 97.8%, respectively (P=0.047). Factors associated with bleeding events were renal failure and mechanical prostheses.

CONCLUSIONS:

The authors have concluded that 1) mortality was statistically similar in the groups; 2) patient characteristics at baseline were a major determinant of late mortality after surgery; 3) there was a tendency toward reoperation in the bioprostheses group; 4) patients using mechanical prosthesis had more bleeding events as time passed; 5) data presented in this paper is in accordance with current literature.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Aortic Valve / Bioprosthesis / Heart Valve Prosthesis / Postoperative Hemorrhage / Heart Valve Prosthesis Implantation Type of study: Controlled clinical trial Limits: Aged / Humans Country/Region as subject: South America / Brazil Language: Portuguese Journal: Rev. bras. cir. cardiovasc Journal subject: Cardiology / General Surgery Year: 2011 Type: Article Affiliation country: Brazil Institution/Affiliation country: Grupo Hospitalar Conceição/BR / UFRGS/BR

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Full text: Available Index: LILACS (Americas) Main subject: Aortic Valve / Bioprosthesis / Heart Valve Prosthesis / Postoperative Hemorrhage / Heart Valve Prosthesis Implantation Type of study: Controlled clinical trial Limits: Aged / Humans Country/Region as subject: South America / Brazil Language: Portuguese Journal: Rev. bras. cir. cardiovasc Journal subject: Cardiology / General Surgery Year: 2011 Type: Article Affiliation country: Brazil Institution/Affiliation country: Grupo Hospitalar Conceição/BR / UFRGS/BR