Reintervention rates vary among surgical aortic valves
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Rates of reintervention and other outcomes varied widely across surgical aortic valve models, with the Perimount models having the best performance, researchers reported in JAMA Network Open.
“These are large differences and show that it is important to compare relevant, high-quality data before procuring prosthetic valves,” Michael Persson, MD, physician and PhD candidate at the department of molecular medicine and surgery at Karolinska Institutet in Stockholm, said in a press release. “Before surgery, these findings can be used as the basis for responding to a patient’s questions and concerns with regards to the choice of prosthetics and their prognosis. After surgery, stricter monitoring may be justified in the case of patients who have received one of the valve models that has been shown to perform poorly in relation to the other valves, in order to detect and treat any complications at an early stage.”
The researchers analyzed 16,983 patients (mean age, 73 years; 63% men) from the SWEDEHEART registry who underwent surgical aortic valve replacement in Sweden from 2003 to 2018. All patients were implanted with one of the following valve models: Perimount (Edwards Lifesciences), Mosaic/Hancock (Medtronic), Biocor/Epic (Abbott), Mitroflow/Crown (LivaNova), Soprano (Sorin) and Trifecta (Abbott).
At 10 years, the adjusted estimated cumulative rate of reintervention was lowest in the Perimount group (3.6%; 95% CI, 3.1-4.2) and highest in the Mitroflow/Crown group (12.2%; 95% CI, 9.8-15.1), according to the researchers. The estimated rate was 5.4% (95% CI, 3.8-7.5) in the Mosaic/Hancock group, 7.5% (95% CI, 5.6-10) in the Biocor/Epic group, 9.5% (95% CI, 4.9-17.8) in the Trifecta group and 11.7% (95% CI, 9.2-14.8) in the Soprano group.
The adjusted cumulative incidence of mortality at 10 years ranged from 44% in the Perimount and Mosaic/Hancock groups to 54% in the Mitroflow/Crown group, the researchers found.
The adjusted cumulative incidence of HF hospitalization at 10 years was lowest in the Perimount group (12.9%; 95% CI, 12-13.8) and highest in the Mitroflow/Crown group (19.9%; 95% CI, 17.6-22.5), Persson and colleagues wrote.
“We will now continue to study how prosthesis-specific factors affect morbidity and mortality following aortic valve surgery,” Ulrik Sartipy, MD, PhD, cardiac surgeon at Karolinska University Hospital and adjunct professor at the department of molecular medicine and surgery at Karolinska Institutet, said in the release. “The aim is that increased knowledge and understanding with regards to the properties of different prosthetics will result in better choices of prosthetic valve for individual patients.”
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