Comparison of outcomes after mitral valve replacement with a mechanical versus a bioprosthetic valve in patients between forty and sixty years of age |
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Authors: | Saket Agarwal Sanjeev Gupta Harpreet Singh Minhas Muhammad Abid Geelani Shiv Sagar Mandiye Amit Banerjee |
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Institution: | (1) Department of Cardiovascular-Thoracic Surgery, G.B. Pant Hospital, University of Delhi, New Delhi, India;(2) Department of CVTS, G.B. Pant Hospital, New Delhi, India |
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Abstract: | Background The American College of Cardiology/American Heart Association (ACC/AHA), guidelines for choice of prosthetic valve based on
patients’ age are difficult to apply to the developing world because of a lower life expectancy and difficulty in maintaining
correct levels of anticoagulation for a variety of reasons. While there is general agreement on the choice of prosthetic valves
for patients below 40 years of age (mechanical) and above 60 years of age (biologic), the 40 to 60 age group remains a grey
zone. The goal of our study was to compare outcomes after mitral valve replacement with a mechanical versus a bioprosthetic
valve in patients between forty and sixty years of age.
Methods From Jan 2003 to July 2008, 250 patients between the ages of 40 and 60, undergoing mitral valve replacement at our institution
were randomized to receive either a mechanical or a bioprosthetic valve. Outcomes in the form of incidence of valve thrombosis
and thromboembolism, bleeding complications, incidence of prosthetic valve endocarditis and survival were compared in the
two groups.
Results Out of 250 patients, 135 patients received mechanical valve and 115 patients were implanted with a bioprosthetic valve. Patients
were followed up for a mean period of 3 years (range 6 months to 4.8 years). The incidence of valve thrombosis was higher
in mechanical valve as compared to bioprosthetic valve (6% vs. 0.9%, p= 0.04). Similarly there was a higher incidence of thromboembolism
in mechanical valves as compared to bioprosthetic valves (4.5% vs. 0%, p=0.03). Bleeding complications occurred more frequently
in mechanical than bioprosthetic valve (6% vs. 0.9%, p=0.04). There was no significant difference in the incidence of prosthetic
valve endocarditis (2.2% vs. 2.7%, p >0.05) or survival at three years (96.2% vs. 97.2%, p > 0.05) in the two groups.
Conclusions Patients in the age group of 40 to 60 years undergoing mitral valve replacement with a mechanical valve have a higher incidence
of thrombotic and bleeding complications as compared to bioprosthetic valve, even though short term survival is similar. This
favours implantation of a bioprosthetic valve in this age group. |
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Keywords: | Thrombosis Mitral valve replacement Endocarditis |
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