Comparison of early treatment outcomes after aortic valve replacement with sutureless, bioprosthetic, and mechanical valves: Our single-center experience with 140 patients
Gökhan İlhan1, Şahin Bozok2, Mustafa Çağdaş Çayır3, Nebiye Tüfekçi4, Şeref Alp Küçüker5
1Department of Cardiovascular Surgery, Muğla Sıtkı Koçman University, Training and Research Hospital, Muğla, Turkey
2Department of Cardiovascular Surgery, Uşak University Faculty of Medicine, Uşak, Turkey
3Department of Cardiovascular Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
4Department of Cardiovascular Surgery, Yıldırım Beyazıt University, Yenimahalle Training and Research Hospital, Ankara, Turkey
5Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
Journal Title:Cardiovascular Surgery and Interventions
Objectives: The aim of the present study was to comparatively assess the perioperative findings and early therapeutic outcomes in patients who underwent aortic valve replacement (AVR) with sutureless, bioprosthetic, and mechanical valves.
Patients and methods: This prospective cohort included a total of 140 patients (78 males, 62 females; mean age 68.5 years range, 36 to 82 years) who underwent AVR in the cardiovascular surgery department of a tertiary care center between January 2013 and September 2016. The patients were divided into three groups according to the valve implanted: sutureless (Group 1, n=48), bioprosthetic (Group 2, n=44), and mechanical (Group 3, n=48) valve groups. Baseline demographic and clinical characteristics, comorbidities, pre- and postoperative echocardiographic findings, hemodynamic parameters, additional interventions, complications, and early therapeutic outcomes were recorded in three patient groups.
Results: Ejection fraction was significantly lower (p=0.026) and the New York Heart Association functional class was significantly higher (p=0.002) in the sutureless valve group. Duration of operation, cross-clamp time, and duration of cardiopulmonary bypass were significantly shorter in the sutureless valve group (p<0.001 for all). Duration of intubation, the amount of erythrocyte suspension transfusion and drainage, and the length of hospitalization and intensive care unit stay were shorter in the sutureless valve group (p<0.001). Comparison of pre- and postoperative echocardiographic findings within each group revealed that maximum and mean aortic gradients were improved in three groups after the operation. However, there was no statistically significant difference in ejection fraction and pulmonary arterial pressure postoperatively among the groups.
Conclusion: Based on our study findings, we conclude that selection of the valves before AVR procedure must be made according to the characteristics of the patient including comorbidities and hemodynamic profile.