Bioprosthesis in aortic valve replacement: long-term inflammatory response and functionality.

BACKGROUND: The evaluation of long-term inflammatory response and function in postoperative patients with aortic valve replacement (AVR) deserves special analysis because it is important to try to prevent reoperation and improve durability and functionality of the prostheses. It is our objective METHODS: In this study, we included a cohort of patients with aortic valve damage treated by AVR with mechanical prosthesis, bio prosthesis and we included a control group. RESULTS: We found that IL-4 and osteopontin levels were higher in patients with mechanical vs biological prostheses (p=0.01 and p=0.04, respectively), osteoprotegerin (OPG) levels were decreased (p=0.01), women had lower levels of ET-1 and IL-6, (p=0.02) (p=0.04), respectively. Patients older than 60 years had decreased levels of IL-1ß p<0.001) and a higher concentration of IL-4 p<0.05). IL-1ß, OPG and TNFα were higher in patients with less than 5 years of evolution vs more than 10 years (p=0.004, p=0.02 and p=0.03, respectively). Factors such as age, gender, prosthetic and elevated IL-1B and ET-1 levels are associated with valve dysfunction prosthetic. These results indicate that the inflammatory involvement present prior to valve replacement may be perpetuated by various factors in the long term. CONCLUSIONS: The findings provide us with the opportunity to effectively treat patients with AVR in the postoperative period, which could prolong the functionality of the bio prostheses. TRIAL REGISTRATION NUMBER: NCT04557345.

[Stentless bioprostheses they are better?]. / Las bioprótesis sin soporte, son mejores?

The history and evolution of the bioprostheses is revised, above all the stentless. According to the international literature these were the first prosthesis that were established to cardiac level with very good results in the haemodynamic aspect, but that to lack an adequate preparation to diminish its antigenicity, to enlarge its resistance and to avoid the deterioration by calcification, less lasting than the mechanics did them. Nevertheless, it given that the real valvular area is much better than in all the other prostheses, their magnificent haemodynamic performance, the not mandatory use of anticoagulants, they do it a good offering for the patients with valvulopathy, above all the aortic. That international experience, now also shows how the use of anticalcification has improved even more the performance of these prostheses, to enlarge considerably its useful time of long-term life, reasons these by that are being utilized in form increasingly more extensive, above all indicating its use in patients more young, which before was almost prohibitive. Finally the initial experience with these bioprotheses in the National Institute of Cardiology of México is mentioned.

Las bioprótesis sin soporte, son mejores? / Stentless bioprostheses they are better?

The history and evolution of the bioprostheses is revised, above all the stentless. According to the international literature these were the first prosthesis that were established to cardiac level with very good results in the haemodynamic aspect, but that to lack an adequate preparation to diminish its antigenicity, to enlarge its resistance and to avoid the deterioration by calcification, less lasting than the mechanics did them. Nevertheless, it given that the real valvular area is much better than in all the other prostheses, their magnificent haemodynamic performance, the not mandatory use of anticoagulants, they do it a good offering for the patients with valvulopathy, above all the aortic. That international experience, now also shows how the use of anticalcification has improved even more the performance of these prostheses, to enlarge considerably its useful time of long-term life, reasons these by that are being utilized in form increasingly more extensive, above all indicating its use in patients more young, which before was almost prohibitive. Finally the initial experience with these bioprotheses in the National Institute of Cardiology of México is mentioned.

[New generation of bioprosthesis of the "Ignacio Chávez" National Institute of Cardiology]. / Nueva generación de bioprótesis del Instituto Nacional de Cardiología "Ignacio Chávez".

The INC has been a pioneer in producing cardiac bioprostheses in Mexico. Since the 1970's it has produced and implanted more than 2,500 bioprostheses, first made of duramater and later on, made of cattle pericardium. Nowadays, it is working on the production of a new generation of bioprostheses of cattle pericardium as well as of pigs with or without support; to these, a system to reduce calcification has been added, as a result of research being performed at the Applied Biotechnics Department. In this work we report the first cases operated with one of these new prostheses, the implant of complete grafts to substitute the ascending aorta and pulmonary artery.