Seguimiento a Largo Plazo Tras Sustitución Valvular Aórtica Con Prótesis Mecánicas O Biológicas En Pacientes De Mediana Edad. Resultados Iniciales De Un Estudio Multicéntrico

Objectives: To investigate the survival and major cardiovascular complications at 10 years (30-day mortality, stroke, prosthetic valve reoperation and major bleeding) in middle-aged patients between 50 to 65 years undergoing isolated aortic valve replacement by severe aortic stenosis with biological or mechanical prostheses. Material and method: Retrospective analytical study of 721 patients from 5 centers with Cardiovascular Surgery in Andalousia between the years 2000-2015. Exclusion criteria include concomitant surgery, reinterventions and infective endocarditis. Matching was performed by 1:1 propensity score to obtain two groups of 181 patients for comparison. Results: The 26% of the sample received a bioprosthesis (n=187), 35% were women, with a mean Euroscore I of 2.5% in mechanical prostheses versus 2.9% biological (P = .05).Ten-year survival was 70% biological versus 78% mechanical, with differences between groups (P = .02) in favor of mechanical group, which disappears after matching (log-rank P = .269). Mechanical prostheses presented more major bleeding (P= .01) versus greater re-intervention in biological ones (P = .01). There were no differences in stroke (P = .660) nor 30-day mortality (P = .08). Mean follow-up was 6.7 +/- 4.3 years in mechanical, versus 6.1 +/- 3.1 years in biological (P = .03). Conclusions: There are no differences in 10-year survival in the matched sample. Mechanical prostheses showed higher major bleeding, and bioprostheses showed increased need for reoperation. The study must be completed up to 15 years to confirm the data. (C) 2018 Sociedad Espanola de Cirugia Toracica-Cardiovascular. Published by Elsevier Espana, S.L.U.