| Institution: | 1. Department of Cardiology, Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada;2. Department of Cardiac Surgery, Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada;1. Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex;2. Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex;3. Surgical Research Core, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex;1. Cardiac Surgery Department, Instituto Cardiovascular, Buenos Aires, Argentina;2. Department of Cardiovascular Anesthesia, Instituto Cardiovascular, Buenos Aires, Argentina;3. Cardiovascular Intensive Care Unit, Instituto Cardiovascular, Buenos Aires, Argentina;1. Cardiac Surgery Center, Beijing Anzhen Hospital Affiliated with Capital Medical University, Beijing, China;2. Beijing Institute of Heart Lung and Vascular Disease, Beijing Anzhen Hospital Affiliated with Capital Medical University, Beijing, China;1. Division of Cardiac Surgery, Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, United Kingdom;2. UK Aortic Surgery Group (UKAS), United Kingdom;1. Division of Thoracic/Vascular Surgery, PeaceHealth Southwest Washington Medical Center, Vancouver, Wash;2. Division of Cardiothoracic Surgery, Oregon Health and Sciences University, Portland, Ore;1. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn;2. Department of Heart Failure and Heart Transplantation, Centro Médico Nacional Siglo XXI, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, Mexico;3. Heart Failure and Heart Transplant Unit, Hospital Clínic de Barcelona, Barcelona, Spain;4. Department of Echocardiography, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico |
| Abstract: | BackgroundProsthetic choice for mitral valve replacement is generally driven by patient age and patient and surgeon preference, and current guidelines do not discriminate between different etiologies of mitral valve disease. Our objective was to assess and compare short- and long-term outcomes after mitral valve replacement among patients with biological or mechanical prostheses in the setting of severe ischemic mitral regurgitation.MethodsBetween 2000 and 2016, 424 patients underwent mitral valve replacement for severe ischemic mitral regurgitation at our institution, using biological prosthesis in 188 (44%) and mechanical prosthesis in 236 (56%). A 1:1 propensity score match (n = 126 per group) and inverse probability of treatment weighting were used to compare groups. Short-term outcomes included in-hospital mortality and other cardiovascular adverse events. Long-term outcomes included survival and hospital readmission for cardiovascular causes, stroke, and major bleeding.ResultsIn-hospital mortality and early postoperative adverse events were similar between groups in the propensity score match and inverse probability of treatment weighting cohorts. Overall long-term survival was similar at 5 and 9 years, but mechanical prosthesis recipients were more frequently readmitted to hospital for cardiovascular causes, including stroke and non-neurological bleeding in propensity score matching and inverse probability of treatment weighting analyses (all P values < .004). Type of prosthesis did not independently influence all-cause mortality (hazard ratio, 1.01; 95% confidence interval, 0.71-1.43; P = .959), but placement of a mechanical prosthesis was associated with increased risk of readmission for cardiovascular events (hazard ratio, 1.65; 95% confidence interval, 1.17-2.32; P = .004) among matched patients.ConclusionsThe type of prosthesis has no influence on long-term survival among patients with severe ischemic mitral regurgitation undergoing mitral valve replacement. There may be an increased risk of neurologic events and serious bleeding associated with mechanical prostheses. |
