J.Jpn. Surg. Soc.. 108(2): 64-68, 2007

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Feature topic

SELECTION OF THE PROSTHESIS FOR AORTIC VALVE REPLACEMENT: MECHANICAL OR BIO?

To clarify the effect of the valve selection on the patients' prognosis, long-term outcome of the patients undergone isolated aortic valve replacement (AVR) with the mechanical or bioprosthetic valve in our institution were investigated. In protocol 1, patients of all ages with isolated AVR (n=472, composed of 166 who received a bioprosthesic valve [group B] and 306 who received a mechanical valve [Group M]) between 1975 and 2004 were investigated. In protocol 2, primary AVR patients aged 50-65 years (n=184, composed of 47 in group B and 137 in group M) were compared. There were no significant differences in freedom from cardiac death, freedom from bleeding, and freedom from endocarditis in Protocols 1 and 2. Significantly fewer redo AVRs were required in group M in both protocols 1 and 2. However, group M was significantly worse in terms of freedom from thromboembolism in protocol 2. As a result, group M was superior to group B in freedom from valve-related events when redo AVR included. When redo AVR was excluded, there was no difference between the two groups in freedom from valve-related events in both protocols 1 and 2. There may thus be an advantage in selecting bioprosthetic valves in young adult patients who required AVR if they accepts the possibility of redo AVR in future.

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