Aortic valve surgery with stented versus stentless bioprosthesis in patients with active infective endocarditis

• Autor(a) principal: Francisca Gonçalves Carvalho de Sousa
• Data de Publicação: 2023
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://hdl.handle.net/10216/150583
• topic: Ciências médicas e da saúde; Medical and Health sciences

Objectives: compare clinical and hemodynamic outcomes after aortic valve replacement (AVR) with a stented (Trifecta-TF) versus a stentless bioprosthesis (Freedom Solo or Solo Smart-FS) in patients with active infective endocarditis (IE). Methods: single-center, retrospective, observational and comparative study including active IE patients who underwent AVR with TF or FS between June 2009 and December 2019. Survival and re-intervention were checked in December 2022. Chi-square or Fisher and Mann-Whitney tests were used for groups comparison and Kaplan-Meier method for time-to-event outcomes. Results: Sixty-eight patients with active IE (21 FS and 47 TF) were included. The median age of FS patients was 68 vs. 69 years in TF (p=0.253). There were 66.7% male patients in the FS vs. 72.3% TF (p=0.508). Median EuroSCORE II was 9.4 (1.0 to 50.8) in FS vs. 16.7 (1.7 to 91.0) in TF (p=0.353). Hospital mortality occurred in 9.5% FS and 25.5% TF (p=0.20). After excluding these patients, the 1-, 5- and 8-year cumulative survival rates for FS vs. TF were 89.5% vs. 88.6%, 84.2% vs. 77.1%, 60.5% vs. 59.1%, respectively (Log-rank p=0.92). There was 1 reoperation in FS at 6 years of follow-up due to structural valve deterioration; and 6 in TF (5 due to endocarditis at 1-, 3-, 5- (n=2) and 11-years of follow-up and 1 due to nonstructural valve deterioration 6-years after AVR:10-years freedom-from-reoperation of 90.9% vs. 80.8%, respectively (Log-rank, p=0.087). Conclusions: TF bioprosthesis was implanted in higher risk patients. Long-term overall survival was similar in stented and stentless aortic bioprosthesis, but FS patients presented higher freedom from prosthesis related reoperation.