Bioprosthetic mitral valve replacement showed no significant difference in 10-year survival compared to mechanical valve replacement in patients aged 50-70 years with rheumatic heart disease (HR 0.91).
Cohort (n=1,691)
No
Does bioprosthetic mitral valve replacement improve survival compared to mechanical mitral valve replacement in patients aged 50-70 years with rheumatic heart disease?
Bioprosthetic and mechanical mitral valve replacement offer comparable 10-year survival, reoperation, stroke, and major bleeding rates in patients aged 50-70 with rheumatic heart disease.
Effect estimate: HR 0.91 (95% CI 0.69-1.21)
Absolute Event Rate: 63.7% vs 63.4%
p-value: p=0.528
Background Rheumatic heart disease (RHD) is a critical problem in developing countries and is the cause of most of the cardiovascular adverse events in young people. In patients aged 50–70 years with RHD requiring mitral valve replacement (MVR), deciding between bioprosthetic and mechanical prosthetic valves remains controversial because few studies have defined the long-term outcomes. Methods 1,691 Patients aged 50–70 years with RHD who received mechanical mitral valve replacement (MVRm) or bioprosthetic mitral valve replacement (MVRb) were retrospectively reviewed in Fuwai hospital from 2010 to 2014. Follow-up ended 31/12/2021; median duration was 8.0 years interquartile range (IQR), 7.7–8.3 years. Propensity score matching at a 1:1 ratio for 24 baseline features between MVRm and MVRb yielded 300 patient pairs. The primary late outcome was postoperative mid- to long-term all-cause mortality. Results Ten-year survival after MVR was 63.4% in the MVRm group and 63.7% in the MVRb group (HR, 0.91; 95% CI, 0.69–1.21; P = 0.528). The cumulative incidence of mitral valve reoperation was 0.0% in the MVRm group and 1.2% in the MVRb group (HR, 0.92; 95% CI, 0.69–1.21; P = 0.530). The cumulative incidence of stroke was 5.5% in the MVRm group and 6.1% in the MVRb group (HR, 0.89; 95% CI, 0.67–1.18; P = 0.430). The cumulative incidence of major bleeding events was 3.3% in the MVRm group and 3.4% in the MVRb group (HR, 0.92; 95% CI, 0.70–1.22; P = 0.560). Conclusions In patients aged 50–70 years with RHD who underwent mitral valve replacement, there was no significant difference on survival, stroke, mitral valve reoperation and major bleeding events at 10 years. These findings suggest mechanical mitral valve replacement may be a more reasonable alternative in patients aged 50–70 years with rheumatic heart disease.
Yu et al. (Tue,) conducted a cohort in Rheumatic heart disease requiring mitral valve replacement (n=1,691). Bioprosthetic mitral valve replacement vs. Mechanical mitral valve replacement was evaluated on 10-year survival (all-cause mortality) (HR 0.91, 95% CI 0.69-1.21, p=0.528). Bioprosthetic mitral valve replacement showed no significant difference in 10-year survival compared to mechanical valve replacement in patients aged 50-70 years with rheumatic heart disease (HR 0.91).