Bioprostheses with Atrial Fibrillation and Mechanical Prostheses in Aortic Valve Replacement[1]

Abstract

Background: Clinical performance of bioprostheses (BP) with presence of atrial fibrillation and/or paced rhythm and mechanical prostheses (MP) in aortic valve replacement was considered a study of importance. Methods: Aortic valve replacement (AVR) was performed in 163 replacements with porcine bioprostheses (Carpentier-Edwards supra-annular) with atrial fibrillation/paced rhythm identified at latest follow-up. Mechanical population was 886 procedures (St. Jude Medical = 436; CarboMedics = 450). Concomitant coronary artery bypass (CAB) was conducted in 40.5 % (66) of BP; 27.0 % (239) of MP. MP patients were all (100 %) on Coumadin and BP patients 35.6 % on acetylsalicylic acid (ASA), 37.4 % Coumadin, 7.4 % Coumadin + ASA, and 19.6 % on no therapy. Results: Major thromboembolism (TE) and hemorrhage (ATH) occurred in 2.4 %/pt-yr (32) for BP and 5.3 %/pt-yr (157) for MP (p < 0.0001); (TE major 1.6 %/pt-yr [21] for BP and 2.1 %/pt-yr [62] for MP [p = 0.24]; ATH = 0.8 %/pt-yr [11] for BP and 3.2 %/pt-yr [95] for MP) (p < 0.0001). There were no predictors of overall TE, TE major, ATH, overall TE + ATH, and TE major + ATH. Age and CAB were predictors of survival. Overall BP survival at 8 years was 97.5 ± 1.5 %; and for MP 66.4 ± 4.8 % (p < 0.01). Actuarial freedom from overall thromboembolism and hemorrhage was 54.5 ± 10.8 % for MP; 85.9 ± 3.1 % for BP (p = 0.0000). For major thromboembolism and hemorrhage, actuarial freedom was 63.4 ± 11.8 % for MP; 91.4 ± 2.5 % for BP (p = 0.0003). Conclusions: Patients with atrial fibrillation/paced rhythm having AVR with bioprostheses with 45 % on Coumadin have greater freedom from thromboembolism and hemorrhage than after AVR with mechanical prostheses on Coumadin.

Atrial fibrillation - paced rhythm - aortic valve replacement

References

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1 Submission - The Thoracic and Cardiovascular Surgeon Presentation - International Symposium Cardiac Bioprostheses 2000