Resultados clínicos y consumo de recursos tras sustitución valvular aórtica con prótesis biológicas o mecánicas en pacientes de 65 años o más

Abstract

IntroductionCurrently in Spain, there is a gap in knowledge regarding clinical outcomes and resource utilization in patients aged ≥65years undergoing aortic valve replacement with a bioprosthesis or mechanical prosthesis. MethodsThis is a retrospective study of patients older than 65years, undergoing aortic valve replacement, isolated or in combination with coronary artery bypass grafting between 2003 and 2016. Comparison between types of prosthesis for mortality and major adverse events and were performed in a propensity score matched cohort using competitive risk analysis. Resource utilization was compared with non-parametric tests and multivariant models. Results522 patients were included (348 bioprosthesis, 174 mechanical). At long term, there were no significant differences in mortality (HR=0.848; 95%CI: 0.663-1.086), stroke (HR=1.672; 95%CI: 0.672-4.161) or valve reintervention (HR=0.454; 95%CI: 0.193-1.071). The risk for major bleeding was significantly higher for patients with a mechanical prosthesis (HR=3.171; 95%CI: 1.102-9.123; p=0.032). Regarding in-hospital resource utilization, mechanical prosthesis were associated to a higher consume. ConclusionsIn patients aged ≥65, patients with a mechanical prosthesis were at higher risk for major bleeding at follow-up. Bioprosthesis were associated with a lower in-hospital resource utilization.