Outcome After Mitral Valve Replacement (mvr) Using Biological Versus Mechanical Valves
Ayse Cetinkaya, Manfred Richter, Markus Schönburg, Wojtek Skwara, Zoltan Szalay, Stefan Hein, Nobel Thaqi, Thomas Walther.
Kerckhoff-Klinik, Bad Nauheim, Germany.
OBJECTIVE: Aim of this study was to compare the outcomes (30-days) after biological (B) versus mechanical (M) mitral valve replacement (MVR) in case mitral valve repair was not feasible
METHODS: From 2005 until 2014 a total of 1121 patients received mitral valve surgery at out institution. Amongst those 275 patients received MVR, 218 received B-MVR and 57 patients received M-MVR. Minimally invasive surgical access was used in 49.1% of patients, thereof in 45.2% (B) versus 63.8% (M); p=0.012. Combined tricuspid valve repair (TVR) was necessary in 19.0%, thereof in 19.4% (B) versus 17.2% (M); p=0.851, ablation for atrial fibrillation in 27.7%, thereof in 26.7% (B) versus 31.6% (M); p=0.507 and LAA-closure in 26.9%, thereof in 27.2% (B) versus 25.9% (M); p=1.00. Underlying mitral valve pathology was degenerative in 95.6%. Amongst those 12.7% with acute endocarditis, 28.7% with MV stenosis and 46.2% restrictive leaflets
RESULTS: Mean patient age was 70.0 years (B) versus 56.0 years (M); p<0.001 and 50.2% (B) versus 43.1% (M) were female; p=0.376. NYHA III-IV occurred in 82.5% (B) versus 82.7% (M); p=0.967 and preoperative emergency/urgent indication for operation was in 16.8% (B) versus in 17.1% (M); p=n.s., acute endocarditis the reason for operation in 12.0% (B) versus in 15.5% (M); p=0.507 was. A simultaneous tricuspid valve repair had to be performed in 19.4% (B) versus 17.2% (M); p=0.851 and kryo ablation was done in 26.8% (B) versus in 31.6% (M); p=0.507. Median MV prosthesis size was 31.0 ±1.9 (B) versus 31.0 ±1.7 (M); p=n.s. Mean red blood cell transfusion was 2.6 ± 7.6 (B) versus 7.2 ± 25.1 (M); p=0.591. Re-thoracotomy rate was 8.8% (B) versus 20.7% (M); P=0.018, wound infection occurred in 2.3% (B) versus in 1.7% (M), p=n.s. and 30 day mortality was 7.4% (B) vs 10.3% (M); p=0.427. Median LOS time was 11 days in (B) versus 14 days in (M); p=0.008
CONCLUSIONS: Mitral valve replacement in case MV repair is not feasible leads to acceptable results. Differences between mechanical and biological prostheses are mostly due to the underlying conditions of the patients. Longer term outcomes will be evaluated
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