Background
Methods
Sample
Ethical considerations
Definitions
Statistical analysis
Results
Variable | Sample (n = 352) | Mechanical valve (n = 247) | Biological valve (n = 105) | p |
---|---|---|---|---|
Mean age ± SD | 52.3 ± 13.4 | 50.8 ± 12.5 | 55.8 ± 14.9 | 0.003 |
Age group - n (%) | ||||
≤ 50 years | 161 (45.7) | 118 (47.8) | 43 (41.0) | < 0.001 |
51 - 60 years | 99 (28.1) | 77 (31.2)* | 22 (21.0) | |
61 - 70 years | 58 (16.5) | 38 (15.4) | 20 (19.0) | |
≥ 71 years | 34 (9.7) | 14 (5.7) | 20 (19.0)* | |
Gender - n (%) | ||||
Male | 165 (46.9) | 116 (47.0) | 49 (46.7) | 1.000 |
Female | 187 (53.1) | 131 (53.0) | 56 (53.3) | |
BMI (Kg/m2) - Mean ± SD | 24.4 ± 4.3 | 24.8 ± 4.5 | 23.4 ± 3.8 | 0.003 |
Obesity** - n (%) | 33 (9.4) | 27 (10.9) | 6 (5.7) | 0.181 |
Morbid obesity*** - n (%) | 1 (0.3) | 1 (0.4) | 0 (0.0) | 1.000 |
Functional class (NYHA) - n (%) | ||||
I-II | 203 (57.7) | 143 (57.9) | 60 (57.1) | 0.990 |
III-IV | 149 (42.3) | 104 (42.1) | 45 (42.9) | |
Pathology – n (%) | 0.719 | |||
Failure | 155 (44.0) | 104 (42.1) | 51 (48.6) | |
Stenosis | 83 (23.6) | 61 (24.7) | 22 (21.0) | |
DI with predominant stenosis | 84 (23.9) | 60 (24.3) | 24 (22.9) | |
DI with predominant failure | 30 (8.5) | 22 (8.9) | 8 (7.6) | |
Rhythm ECG – n (%) | ||||
Sinus | 147 (42.0) | 114 (46.3)* | 33 (31.7) | |
Atrial fibrillation | 198 (56.6) | 129 (52.4) | 69 (66.3)* | 0.039 |
Others | 5 (1.4) | 3 (1.2) | 2 (1.9) | |
Chronic atrial fibrillation - n (%) | 169 (48.0) | 112 (45.3) | 57 (54.3) | 0.156 |
Diabetes mellitus - n (%) | 25 (7.1) | 18 (7.3) | 7 (6.7) | 1.000 |
COPD - n (%) | 56 (15.9) | 39 (15.8) | 17 (16.2) | 1.000 |
Stroke - n (%) | 24 (6.8) | 17 (6.9) | 7 (6.7) | 1.000 |
SAH - n (%) | 144 (40.9) | 105 (42.5) | 39 (37.1) | 0.413 |
Creatinine > 2 mg/dl – n (%) | 17 (4.8) | 9 (3.6) | 8 (7.6) | 0.187 |
Dialysis - n (%) | 3 (0.9) | 1 (0.4) | 2 (1.9) | 0.213 |
Emergency surgery - n (%) | 22 (6.3) | 10 (4.0) | 12 (11.4) | 0.017 |
Endocarditis - n (%) | 36 (10.2) | 22 (8.9) | 14 (13.3) | 0.288 |
Rheumatic fever - n (%) | 153 (43.5) | 112 (45.3) | 41 (39.0) | 0.331 |
Variables | n | Total sample | Mechanical valve (n = 247) | Biological valve (n = 105) | p |
---|---|---|---|---|---|
Total surgical time (min) - mean ± SD | 348 | 183.2 ± 61.2 | 175.5 ± 60.0* | 202.5 ± 60.5 | < 0.001 |
ECC time (min) - mean ± SD | 352 | 76.5 ± 33.2 | 75.4 ± 34.7 | 79.2 ± 29.4 | 0.322 |
ECC > 120 min - n (%) | 352 | 35 (9.9) | 20 (8.1) | 15 (14.3) | 0.114 |
Ischemia time (min) - mean ± SD | 350 | 57.6 ± 25.4 | 57.2 ± 24.7 | 58.4 ± 27.0** | 0.691 |
Variable | Sample (n = 352) | Mechanical prosthesis (n = 247) | Biological prosthesis (n = 105) | p |
---|---|---|---|---|
Hospitalization time (days) - median (P25–P75) | 13 (10–20) | 12 (9–18) | 17 (13–27) | < 0.001 |
ICU time (days) - median (P25–P75) | 3 (2.8–4) | 3 (2.8–3.8) | 3.3 (2.9–4.2) | 0.009 |
PO hospitalization time (days) - median (P25–P75) | 8 (7–11) | 8 (7–10) | 10 (8–14) | < 0.001 |
Mechanical ventilation time (h) - median (P25–P75) | 15 (9–20) | 14 (8–20) | 17 (12–24) | < 0.001 |
Mechanical ventilation > 5 days - n (%) | 7 (2.0) | 4 (1.6) | 3 (2.9) | 0.431 |
AMI - n (%) | 3 (0.9) | 2 (0.8) | 1 (1.0) | 1.000 |
Stroke - n (%) | 7 (2.0) | 5 (2.0) | 2 (1.9) | 1.000 |
Arrhythmia requiring cardioversion - n (%) | 13 (3.7) | 7 (2.8) | 6 (5.7) | 0.219 |
Dialysis | 2 (0.6) | 0 (0.0) | 2 (1.9) | 0.088 |
Reoperation due to bleeding - n (%) | 15 (4.3) | 10 (4.0) | 5 (4.8) | 0.776 |
Cardiac tamponade - n (%) | 10 (2.8) | 7 (2.8) | 3 (2.9) | 1.000 |
Permanent TAVB | 4 (1.1) | 2 (0.8) | 2 (1.9) | 0.586 |
Survival data
Variable | HR (95% CI) | p |
---|---|---|
Mechanical prosthesis | 0.96 (0.61-1.50) | 0.855 |
Renal failure
|
4.41 (2.36-8.25)
|
< 0.001
|
Bleeding events
|
3.13 (1.68-5.80)
|
< 0.001
|
Age group
| ||
≤ 50 years | 1.0 | |
51–60 years | 1.39 (0.82-2.38) | 0.224 |
61–70 years
|
1.98 (1.11-3.56)
|
0.022
|
≥ 71 years
|
2.96 (1.54-5.71)
|
0.001
|
Mitral regurgitation | 1.49 (0.97-2.29) | 0.069 |
SAH | 1.45 (0.95-2.23) | 0.088 |
Chronic atrial fibrillation | 1.46 (0.91-2.33) | 0.114 |
Emergency surgery | 1.69 (0.82-3.47) | 0.153 |
Diabetes mellitus | 1.62 (0.82-3.19) | 0.163 |
Ischemia time | 1.01 (0.99-1.01) | 0.180 |
ICU time (h) | 1.00 (0.99-1.00) | 0.492 |
Hospitalization time | 1.01 (0.99-1.02) | 0.501 |
MV time (h) | 1.00 (1.00-1.01) | 0.589 |
Diameter | 1.03 (0.92-1.15) | 0.654 |
CHF class III and IV | 1.10 (0.70-1.75) | 0.675 |
Postoperative stroke | 1.36 (0.31-5.99) | 0.681 |
COPD | 0.91 (0.48-1.70) | 0.759 |
ECC time > 120 min | 1.11 (0.40-3.10) | 0.843 |
Rheumatic fever | 1.02 (0.60-1.71) | 0.949 |
Variable | Sample (n = 352) n (%) | Mechanical prosthesis (n = 247) n (%) | Biological prosthesis (n = 105) n (%) | p |
---|---|---|---|---|
Reoperation for valve replacement | 33 (9.4) | 16 (6.5) | 17 (16.2) | 0.008 |
Bleeding events | 23 (6.5) | 18 (7.3) | 5 (4.8) | 0.521 |
Thromboembolic events | 7 (2.0) | 5 (2.0) | 2 (1.9) | 1.000 |
Total number of deaths | 91 (25.9) | 52 (21.1) | 39 (37.1) | 0.003 |
Perioperative death | 21 (6.0) | 10 (4.0) | 11 (10.5) | 0.037 |
ICU* | 9 (2.6) | 4 (1.6) | 5 (4.8) | 0.133 |
Hospital* | 11 (3.1) | 5 (2.0) | 6 (5.7) | 0.092 |
Others** | 70 (19.9) | 42 (17.0) | 28 (26.7) | 0.053 |
Cause of death* | Sample (n = 91) n (%) | Mechanical prosthesis (n = 52) n (%) | Biological prosthesis (n = 39) n (%) | p |
---|---|---|---|---|
Prosthesis-related | 32 (35.2) | 18 (34.6) | 14 (35.9) | 1.000 |
Others | 59 (64.8) | 34 (65.4) | 25 (64.1) | 1.000 |
Cardiac | 21 (23.1) | 12 (23.1) | 9 (23.1) | 1.000 |
Non-cardiac | 36 (39.6) | 21 (40.4) | 15 (38.5) | 1.000 |
Sudden or unexplained | 2 (2.2) | 1 (1.9) | 1 (2.6) | 1.000 |
Variable | HR (95% CI) | p |
---|---|---|
Biological prosthesis | 1.89 (0.94-3.82) | 0.075 |
Male gender
|
2.54 (1.20-5.35)
|
0.015
|
Valve prosthesis diameter
|
0.82 (0.69-0.97)
|
0.019
|
Endocarditis
|
2.44 (1.04-5.70)
|
0.040
|
Arrhythmia | 2.92 (0.86-9.89) | 0.085 |
Emergency surgery | 1.98 (0.71-5.56) | 0.192 |
RF | 1.12 (0.24-5.29) | 0.885 |
Variable | HR (95% CI) | P |
---|---|---|
Mechanical prosthesis | 1.90 (0.69–5.18) | 0.213 |
BMI ≥ 30 kg/m
2
|
4.41 (1.66–11.8)
|
0.003
|
COPD
|
2.87 (1.19–6.91)
|
0.019
|
MV > 5 days
|
5.34 (1.13–25.4)
|
0.035
|
Mitral regurgitation
|
2.56 (1.05–6.25)
|
0.040
|
SAH | 2.31 (0.96–5.56) | 0.062 |
Ischemia time | 1.01 (0.99–1.02) | 0.131 |
Diabetes mellitus | 1.74 (0.48–6.36) | 0.404 |
Hospitalization time | 1.01 (0.98–1.03) | 0.740 |
Rheumatic fever | 1.15 (0.41–3.27) | 0.790 |
RF | 1.28 (0.14–11.4) | 0.828 |