Abstract
Background
Prosthetic 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.
Methods
Between 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.
Results
In-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.
Conclusions
The 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.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
AF (atrial fibrillation), BP (biological prosthesis), CABG (coronary artery bypass grafting), IMR (ischemic mitral regurgitation), IPTW (inverse probability of treatment weight), MP (mechanical prosthesis), MR (mitral regurgitation), MVR (mitral valve replacement), PSM (propensity score matching), TIA (transient ischemic attack)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 02, 2021
Accepted:
January 24,
2021
Received in revised form:
December 29,
2020
Received:
August 22,
2020
Footnotes
Mr Bernard is supported by a doctoral scholarship from Fonds de Recherche du Québec - Santé and Dr Pibarot holds the Canada Research Chair in Valvular Heart Diseases from Canadian Institutes of Health Research, Ottawa, Ontario, Canada. The funding sources had no involvement in either the conduct or the preparation of the article.
Identification
Copyright
© 2021 by The American Association for Thoracic Surgery
ScienceDirect
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