masterThesis
Es el reimplante valvular mejor que el bentall biológico modificado para tratar aneurismas de la raíz asociados a insuficiencia?
Fecha
2010Registro en:
TEME 0053 2009
Autor
Obando López, Carlos Eduardo
Bresciani, Renato
Camacho Mackenzie, Jaime
Carreño Jaimes, Marisol
Gutiérrez, Héctor
Sandoval, Néstor
Umaña Mallarino, Juan Pablo
Institución
Resumen
Compare functional results, Morbility and median and short term survival, after modified Bentall procedure with Freestyle valve vs. Valvular Reimplantation Tirone David, for the aortic valve insufficiency secondary to aortic root aneurysm.
DESIGN: Revision of institutional registers of 88 patients treated from January 2003 to august 2009 with aortic insufficiency secondary to aortic root aneurysm without valve damage, distributed in two cohorts: Group 1 (Modified Bentall), Group 2 (Valvular Reimplantation). Perioperative complications were evaluated as well as transfusions, hospitalization days, median term observation for valve insufficiency, functional class, ventricular function and survival. The solidity of the results were verified by propensity analysis with balance of groups.
RESULTS: Group (1) 51(57.9%) patients and group (2) 37(42.1%). Although group 2 is younger, similar patterns of comorbility, aortic root anatomy, function and ventricular diameters of both groups make them comparable. Follow up for 3.3 years (IQR 2.0-4.4).
Early Mortality 2(3.8%) vs. 0 p =0.2 and late 2(4.1%) vs. 0 p=0.33. The analysis of stratified co variables in blocks of distribution does not identify differences in mortality. The analysis of survival of mortality and survival free of events identifies similar results between the groups (Log-Rank chi2=0.9, p=0.3); including aortic insufficiency = II early (3.8% vs. 0, p=0.2) and late (3.8%vs 0, p=0.1), perioperative transfusions, reinterventions by bleeding (2.3% vs. 3.4%, p=0.4), arrhythmias (25.5% vs. 13.5%, p=0.2), and neurologic dysfunction(5.7% vs. 2.9%, p=0.9). Finally total hospitalization (6.5 {1-35} vs. 4{3-16} p=0.001) and Intensive care staying (2.5 {1-21} vs. 1{1-16} p=0.001) is superior in group 1.
CONCLUSIONS: The treatment of aortic root aneurysm associated to aortic valve insufficiency without structural damage, with valve reimplantation or Modified Bentall (Biological) offers similar results. Valve preservation is associated to shorter hospitalization stay, but there is no difference in post operative complications, functional status, valve insufficiency, ventricular function, mortality, and survival free of adverse events.