Biological or mechanical mitral valve replacement in patients 50–70 years of age—a propensity-adjusted analysis. (9th February 2022)

• Record Type: Journal Article
• Authors: Leviner, Dror B; Zafrir, Barak; Saliba, Walid; Stein, Nili; Shiran, Avinoam; Sharoni, Erez
• Is Part Of: European journal of cardio-thoracic surgery. Volume 62:Number 2(2022)
• Publication Date: 2022-02-09
• Subjects: Mitral valve -- Valve replacement -- Mechanical valve -- Bioprosthetic valve; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezac073
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: The choice of a bioprosthetic valve (BV) over a mechanical valve (MV) in middle-aged adults in the mitral position is still under debate. Each valve type has benefits and drawbacks. We examined the mid-term survival of patients aged 50–70 years after BV versus MV mitral valve replacement (MVR). METHODS: We conducted a multicentre, retrospective analysis of patients aged 50–70 years undergoing MVR from 2005 to December 2018 in 4 medical centres in Israel. To control for between-group differences, we used propensity-adjusted analysis. The primary end point was all-cause mortality. Secondary end points included reoperation, cerebrovascular accident and bleeding. RESULTS: During the study period, 2125 MVR procedures were performed. Of these, 796 were eligible for inclusion [539 (67.8%) MV replacement and 257 (32.2%) BV]. The mean age was 61.0 ± 5.4. There were 287 deaths during 4890 person-years of follow-up. The adjusted hazard ratio was (1.13 [0.85–1.49], P = 0.672). There was also no difference in the secondary end points. Subgroup analysis of patients aged 50–64 years showed a higher risk of mortality with BV (hazard ratio = 1.50 [1.07–2.1], P = 0.018). Reoperation was a strong predictor of mortality during the study period (72.2%). CONCLUSIONS: In patients aged 50–70 years, we found an interaction between age and MV or BV outcomes—those younger than 65 years gained a mortality advantage with MV, while outcomes were similar in the 65–70 age group. this supports the current guidelines recommending using MV in patients <65 years of age. Abstract : Mitral valve replacement (MVR) still accounts for a large part of mitral operations: even though mitral valve repair is the preferred surgical approach for degenerative mitral valve disease, MVR is still commonly performed for rheumatic mitral valve disease, functional mitral valve disease, mitral valve endocarditis and some degenerative mitral valvulopathy.