PROTESI VALVOLARI CARDIACHE:

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Presentation transcript:

PROTESI VALVOLARI CARDIACHE: INDICAZIONI E DATI EPIDEMIOLOGICI IN ITALIA Prof. Carlo Antona Direttore Dipartimento Cardio-Cerebro-Vascolare U.O.Cardiochirurgia ASST Fatebenefratelli-Sacco Università degli Studi di Milano

VALVE REPAIR/REPLACEMENT: HOSPITALIZATION TREND

VALVE REPAIR/REPLACEMENT: 30-DAY MORTALITY

CARDIAC PROSTHETIC VALVES Mechanical valves: Single tilting disc Bileaflet Biological valves: Homografts Pulmonary autografts Porcine Pericardial bovine Pericardial equine Biological valves: Sutureless/ Rapid deployment TAVI Xenograft: Stented Stentless

MECHANICAL PROSTHESES Starr-Edwards Medtronic-Hall SJM Regent

STENTED BIOPROSTHESES Pericardial Porcine Carpentier-Edwards Medtronic SJM

STENTLESS BIOPROSTHESES Medtronic Freestyle

SUTURELESS BIOPROSTHESES ATS 3f Enable Medtronic Perceval S Sorin - Livanova Intuity Elite Edwards

TAVI Edwards Centera Medtronic Engager Boston Scientific Lotus CoreValve Evolut R Edwards Sapien XT Direct Flow Medical JenaValve St Jude Portico Symetis

CARDIAC PROSTHETIC VALVES: PROS & CONS ANTICOAGULANT-RELATED BLEEDING + THROMBOEMBOLISM (INR, concomitant ASA/dual antiplatelet therapy, patient’s risk factors) Mechanical valves Biological valves STRUCTURAL VALVE DETERIORATION (mitral > aortic prosthesis, risk of reoperation slightly higher than first operation)

THE PROSTHESIS CHOICE…. SOME ISSUES ABOUT THE PROSTHESIS CHOICE…. Valve-related event-free survival Structural valve deterioration (11 years in 20-year-old patients, 25 years in 65-year-old patients) Anticoagulation treatment duration (valve repair versus mechanical) Thrombosis/thromboembolism Bleeding Pregnancy Infections

VS

CONCLUSIONS - I In the last years, we assisted to a progressive increase in the use of biological valves compared to mechanical ones TAVI procedures continue growing up among old inoperable patients; moreover, there is a trend towards increase also in intermediate-risk cathegory 80% of aortic valve replacement is performed with biological prostheses

CONCLUSIONS - II Mitral valve repair represents about 50% of mitral procedures Mitral valve replacement is performed in 60% of cases with tissue valves and in 40% with mechanical prostheses Prosthesis choise also depends on: knowledge of anticoagulant therapy caracteristics word of mouth new possibilities with TAVI prostheses (V in V) THANK-YOU