Mitral valve replacement using - PowerPoint Presentation

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Mitral valve replacement using Carpentier-Edwards pericardial bioprosthesis in patients with rheumatic heart disease aged below 40 years: 17-year results

Chowdhury UK

et al. Heart Lung Circ

. 2018;

27

: 864–71.

Study details

Aim:

To evaluate survival, quality of life, and incidence of thromboembolism, IE, SVD and valve‑related dysfunction for patients younger than 40 years implanted with tissue heart valvesStudy type: Prospective, observational, single-centre studyEndpoints: Quality of life without anticoagulation, survival and incidence of thromboembolism, IE, SVD and valve‑related dysfunctionMethods: Included all patients with rheumatic heart disease undergoing mitral valve replacement with the PERIMOUNT valve (model 6900 – mitral) between January 2000 and December 2016Echocardiographic assessment was done immediately after surgery, then within 6 months and annually thereafterAnticoagulation therapy for most patients with normal sinus rhythm was stopped after 12 weeksAll patients were prescribed life-long aspirin, unless contraindicatedQoL was assessed using the WHO quality of life questionnaire at the last follow-up visit

IE: infective endocarditis; QoL: quality of life; SVD: structural valve degeneration; WHO: World Health Organization

Key study results (1/2)

Patient characteristics:

132 patients (38.6% male; mean age 30.1 ± 5.5 years [range 12–39 years])

NYHA class: III (87.1%) and IV (12.8%)Early outcomes:Mortality: 1.5% (due to low output syndrome)Hospital morbidity: reoperation for excessive bleeding (2.3%), respiratory failure (1.5%) and deranged prothrombin time requiring pericardiocentesis (2.3%)Mean hospital stay: 8.8 ± 5 daysNYHA: New York Heart Association

Key study results (2/2)

Late outcomes

Mortality: 1.5%

Actuarial survival at 204 months: 96.9 ± 0.01%Actuarial event-free survival at 204 months: 93.4 ± 0.03%One case of thromboembolismNo cases of IENYHA class: I (88.2%) and II (11.7%)Severe SVD: 4.7% (7–10 years after valve replacement)QoL: generally goodIE: infective endocarditis; NYHA: New York Heart Association; QoL: quality of life; SVD: structural valve degeneration

Limitations

Single-centre, observational study – results may not translate to patients at other centres

Effect of reoperation for SVD on long-term survival is unknown

Conclusion Use of tissue heart valves is satisfactory in patients under 40 years, with excellent survival, low complication rates and a good quality of life. The choice of biological or mechanical valves in young patients should consider patient preference, likelihood of reoperation, desire for pregnancy, problems with monitoring prothrombin times and the patient’s ability or willingness to take anticoagulants. A mechanical valve is not necessarily the most appropriate choice for young adults requiring first-time, single left-sided valve replacement.

Study limitations and conclusion

iEOA

: indexed effective orifice area; SVD: structural valve degeneration

This document is a summary of the Chowdhury UK et al. paper and covers key information including aim, type of study, methods, results, limitations and conclusions.The full publication is available at:

http://bit.ly/chowdhury2018

Abbreviations

IE: infective endocarditisNYHA: New York Heart AssociationQoL: quality of lifeSVD: structural valve degeneration WHO: World Health OrganizationFor professional use. See instructions for use for full prescribing information, including indications, contraindications, warnings, precautions and adverse events.Edwards Lifesciences devices placed on the European market meeting the essential requirements referred to in Article 3 of the Medical Device Directive 93/42/EEC bear the CE marking of conformity.Edwards, Edwards Lifesciences, the stylized E logo, Carpentier-Edwards, PERI, and PERIMOUNT are trademarks of Edwards Lifesciences Corporation. All other trademarks are property of their respective owners.© 2019 Edwards Lifesciences Corporation. All rights reserved. E9296/03-19/SUR