Comparison Of Long-term Outcomes After Replacement Of Mitral Valves By Biological And Mechanical Valves
Ayse Cetinkaya1, Julia Poggenpohl1, Karin Bramlage2, Stefan Hein1, Mirko Doss1, Peter Bramlage2, Markus Schönburg1, Manfred Richter1.
1Department of Cardiac Surgery, Kerckhoff-Heart Center, Bad Nauheim, Germany, 2Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.
Background and aim: This study compared long-term outcomes of biological and mechanical mitral valve replacement (MVR) in patients requiring replacement of the mitral valve where repair was not feasible. Methods: A single-centre registry of patients receiving MVR between 2005 and 2015 was established. 30-day mortality and long-term outcomes were analysed and compared. Results: 275 patients underwent MVR (218 biological, 57 mechanical valves). Patients receiving biological valves were older (p < 0.001), had a higher log EuroSCORE (p = 0.005) and received less minimally invasive surgery (p = 0.014). Immediate procedural mortality was 1.5%, which only occurred in the biological valve group. At 30 days, 8.4% of patients had deceased, 3.3% experienced stroke and 6.2% received a pacemaker. The rate of renal failure (7.6%) was lower in the biological (6.4%) than in the mechanical valve group (12.3%; adjOR 0.32 [0.11-0.97]). Frequent long-term complications were stroke (7.9%) and bleeding (4.9%), with bleeding complications being higher in the mechanical valve group (p = 0.037). During the follow-up period biological valves showed a better survival rate during the first year, which shifted after 5 years in favour of mechanical valves. At 10 years, survival rates were 71.5% vs. 76.4% in the biological and mechanical valve groups. Hazard Ratio after adjustment was 0.629 (95%CI 0.322-1.229) in favour of biological valves. Conclusion: Mechanical valve implantation is associated with an increased risk of bleeding and there is a potential survival benefit during the first 5 years after surgery for patients receiving a biological valves.
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