15 Years Outcomes Following Bioprosthetic vs Mechanical Aortic Valve Replacement Between 50-65 Years (ANDALVALVE)

July 24, 2018 updated by: Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud

15 Years Outcomes Following Bioprosthetic vs Mechanical Isolated Aortic Valve Replacement for Aortic Stenosis in Patients Aged 50 to 65 Years in South Spain. The Andalousian Aortic Valve Multicentric Study (ANDALVALVE)

Currently there is an increase in the use of bioprosthesis worldwide (> 70% according to national data of the Spanish Society of Thoracic and Cardiovascular Surgery).

There is conflicting evidence regarding the long-term survival of patients aged 50-65 years with mechanical (M) or biological (B) aortic prostheses. General consensus of greater complications associated with the use of long-life anticoagulation in M and of reoperation in B.

Similar survival with lower MACCE complications in bioprosthesis could reconsider their choice in patients aged 50-65 years, specially in the current TAVI era.

The investigators are going to perform a multicentric retrospective observational study (Registry) about 15 year-outcomes Following Bioprosthetic vs Mechanical Isolated Aortic Valve Replacement for Aortic Stenosis in Patients Aged 50 to 65 Years in 5 Cardiovascular Surgery Centers in Andalousia (south Spain)

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Objectives The main objective is to analyze long-term survival (15 years) and major cardiovascular complications (MACE, (death of any cause, neurological events (TIA / stroke), any prosthesis reoperation, and major bleeding), in patients aged 50-65 years who underwent isolated aortic valve replacement (AVR) due to severe aortic stenosis . Secondary objectives were to analyze the evolution of transprosthetic gradients by echocardiography, type of INR control, and degree of significant structural degeneration in bioprostheses.

Material and Method: A retrospective analytical study of patients aged 50-65 years who underwent AVR surgery for stenosis between 2000-2015 in all centers with a Cardiovascular Surgery Dept. in Andalousia (SPAIN) as an inclusion criterion. As exclusion criteria, autonomic change of residence, need for concomitant surgery, previous cardiac interventions and endocarditis. Survival analysis and clinical data will be performed through the Diraya Health Care medical records (DAE), direct telephone contact with family and / or relatives, A crude analysis of the data and a posterior analysis by propensity score matching with the help of the Foundation for Biomedical Research of Malaga (IBIMA) with SPSS software will be carried out using a 1: 1 "nearest neighbour" matching protocol based on the Number of total bioprosthesis. A total sample of more than 1200 cases is expected, of which about 380 would be bioprostheses that would serve as a basis for the pairing. To find a 10% difference in the primary endpoint, two groups of 325 patients are required for a p = 0.05 and 80% for a bilateral contrast of two independent proportions. Sub-analysis will be performed by subgroups of age (50-59 vs. 60-65 years) and another according to the mark of the 2 prostheses of each type most used. All statistical analyzes will be two-tailed with an alpha error of 0.05 to consider statistically significant data, and will be reviewed by IBIMA biostatistics.

Conclusions: A positive result (similar survival and prosthetic durability in group B, with lower complications) could change the current indications of AVS in our environment, allowing the age of indication of bioprostheses to be reduced below 60 years.

Study Type

Observational

Enrollment (Actual)

1200

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Spain
      • Cadiz, Spain
        • Hospital Universitario Puerta del Mar
      • Cordoba, Spain
        • Hospital Universitario Reina Sofia
      • Granada, Spain
        • Hospital Universitario Virgen de las Nieves
      • Malaga, Spain
        • Hospital Universitario Virgen de la Victoria
      • Sevilla, Spain
        • Hospital Universitario Virgen Del Rocio
      • Sevilla, Spain
        • Hospital Universitario Virgen Macarena
    • Málaga
      • Malaga, Málaga, Spain
        • Hospital Regional Universitario de Malaga

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

50 years to 65 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Patients aged 50-65 years who underwent isolated aortic valve replacement (AVR) for severe aortic stenosis from years 2000-2015 both inclusive, with bioprosthesis or mechanical prosthesis

Description

Inclusion Criteria:

  • Patients aged 50-65 years who underwent isolated aortic valve replacement (AVR) for severe aortic stenosis from years 2000-2015 both inclusive

Exclusion Criteria:

  • Not reported Residency change (unreachable)
  • Need of concomitant surgery
  • Reoperations
  • Infective endocarditis

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Cohort
  • Time Perspectives: Retrospective

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Bioprosthesis
All patients operated on of isolated AVR with a bioprosthesis implantation between 2000-2015 and age 50-65 years both inclusive.
Procedure: bioprosthesis implantation between 2000-2015
Implantation of a bioprosthesis in aortic position with cardiopulmonary bypass
Mechanical prosthesis
All patients operated on of isolated AVR with a Mechanical prosthesis implantation between 2000-2015 and age 50-65 years both inclusive.
Procedure: mechanical prosthesis implantation between 2000-2015
Implantation of a mechanical prosthesis in aortic position with cardiopulmonary bypass

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of participants alive
Time Frame: From date of surgery until the date of death from any cause, assessed up to 17 years
Survival since surgery
From date of surgery until the date of death from any cause, assessed up to 17 years
Late postoperative endpoint of 4 MACE complications
Time Frame: From date of surgery until the date of first documented MACE (see description) or date of death from any cause, whichever came first, assessed up to 17 years
All cause Mortality, major bleeding, cerebrovascular or transient ischemic accident, and need of any prosthesis reintervention (Major Adverse Cardiovascular Events, MACE)
From date of surgery until the date of first documented MACE (see description) or date of death from any cause, whichever came first, assessed up to 17 years

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Total in-Hospital and Intensive Care Unit stay (in days)
Time Frame: From date of surgery to discharge of the unit and Hospital, up to 6 months
Total in-Hospital and Intensive Care Unit stay (in days)
From date of surgery to discharge of the unit and Hospital, up to 6 months
Cardiopulmonary bypass time in minutes needed in the surgery
Time Frame: day 1 after surgery
Cardiopulmonary bypass time in minutes needed in the surgery
day 1 after surgery
Cross-clamp ischemic heart time in minutes needed in the surgery
Time Frame: day 1 after surgery
Cross-clamp ischemic heart time in minutes needed in the surgery
day 1 after surgery
Transfusional requirements (number of red packed cells, fresh frozen plasma and platelets)
Time Frame: rom date of surgery until the date of first documented transfusional requirement assessed up to 17 years
transfusional needs in long term follow up
rom date of surgery until the date of first documented transfusional requirement assessed up to 17 years
Structural valve deterioration (SVD) in bioprosthesis
Time Frame: From date of surgery until the date of first documented SVD assessed up to 17 years
increase in 20 mmHg in transaortic gradient since discharge echocardiography, any aortic regurgitation greater than moderate or need for bioprosthesis reoperation
From date of surgery until the date of first documented SVD assessed up to 17 years
Cardiovascular cause of rehospitalization
Time Frame: f first documented Cardiovascular cause of rehospitalization assessed up to 17 years
any cardiovascular cause which need rehospitalization after surgery
f first documented Cardiovascular cause of rehospitalization assessed up to 17 years
Postsurgery Mean transprosthetic gradients in mmHg
Time Frame: From date of surgery until the date of Hospital Discharge, documented first Mean transprosthetic gradient in mmHg assessed by echocardiography after surgery.
measured by the first echocardiography after surgery
From date of surgery until the date of Hospital Discharge, documented first Mean transprosthetic gradient in mmHg assessed by echocardiography after surgery.
Late Mean transprosthetic gradients in mmHg
Time Frame: From date of surgery until the date of last documented echocardiography assessed up to 17 years
measured by the last echocardiography in follow up
From date of surgery until the date of last documented echocardiography assessed up to 17 years
Any prosthetic infective endocarditis
Time Frame: From date of surgery until the date of first documented prosthetic infective endocarditis, assessed up to 17 years
definite diagnosis of early or late infective endocarditis
From date of surgery until the date of first documented prosthetic infective endocarditis, assessed up to 17 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud

Investigators

  • Principal Investigator: EMILIANO A RODRIGUEZ-CAULO, MD, PhD, FIMABIS, HOSPITAL VIRGEN DE LA VICTORIA DE MÁLAGA

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 1, 2017

Primary Completion (Actual)

April 1, 2018

Study Completion (Actual)

April 1, 2018

Study Registration Dates

First Submitted

July 12, 2017

First Submitted That Met QC Criteria

August 1, 2017

First Posted (Actual)

August 4, 2017

Study Record Updates

Last Update Posted (Actual)

July 26, 2018

Last Update Submitted That Met QC Criteria

July 24, 2018

Last Verified

January 1, 2018

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • ANDALVALVE STUDY

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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