Key result
Mechanical mitral valve replacement was associated with a lower reoperation rate (p=0.02) but similar survival (p=0.4) compared to bioprosthetic valves in matched patients with mitral stenosis.
Why the study?
Does mechanical mitral valve replacement improve survival or reduce reoperations compared to bioprosthetic mitral valve replacement in patients with severe mitral stenosis?
Cohort (n=195)
No
Does mechanical mitral valve replacement improve survival or reduce reoperations compared to bioprosthetic mitral valve replacement in patients with severe mitral stenosis?
p-value: p=0.02
In patients with severe mitral stenosis, mechanical valve replacement is associated with a lower reoperation rate compared to bioprosthetic valves, but long-term survival is similar when matched for age and mitral regurgitation.
Mechanical valves may reduce reoperations in severe mitral stenosis; leaves open survival and functional impact for randomized confirmation.
OBJECTIVES: Mitral valve replacement with either a bioprosthetic or a mechanical valve is the treatment of choice for severe mitral stenosis. However, choosing a valve implant type is still a subject of debate. This study aimed to evaluate and compare the early and late outcomes of mitral valve replacement [mechanical (MMV) vs. bioprosthetic (BMV)] for severe mitral stenosis. METHODS: A retrospective cohort study was performed on data involving mitral stenosis patients who have undergone mitral valve replacement with either BMV (n = 50) or MMV (n = 145) valves from 1999 to 2012. Data were collected from the patients' records and follow-up through telephone calls. Data were analyzed for early and late mortality, New York Heart Association (NYHA) functional classes, stroke, pre- and postoperative echocardiographic findings, early and late valve-related complications, and survival. Chi-square test, logistic regression, Kaplan-Meier curve, and dependent proportions tests were some of the tests employed in the analysis. RESULTS: A total of 195 patients were included in the study with a 30-day follow-up echocardiogram available for 190 patients (97.5%), while 103 (53%) were available for follow-up over the telephone. One patient died early postoperatively; twelve patients died late in the postoperative period, six in the bioprosthesis group and six in the mechanical group. The late mortality had a significant association with postoperative stroke (p < 0.001) and postoperative NYHA Classes III and IV (p = 0.002). Postoperative NYHA class was significantly associated with age (p = 0.003), pulmonary disease (p = 0.02), mitral valve implant type (p = 0.01), and postoperative stroke (p = 0.02); 14 patients had strokes in the mechanical (9) and in the bioprosthetic (5) groups. NYHA classes were significantly better after the replacement surgeries (p < 0.001). BMV were significantly associated with worse survival (p = 0.03), worse NYHA postoperatively (p = 0.01), and more reoperations (p = 0.006). Survival was significantly better with MMV (p = 0.03). When the two groups were matched for age and mitral regurgitation, the analysis revealed that BMV were significantly associated with reoperations (p = 0.02) but not significantly associated with worse survival (p = 0.4) or worse NYHA (p = 0.4). CONCLUSION: MMV replacement in mitral stenosis patients is associated with a lower reoperation rate, but there was no difference in survival compared with BMV replacement.
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Mosa et al. (2016) conducted a cohort in Severe mitral stenosis (n=195). Mechanical mitral valve replacement vs. Bioprosthetic mitral valve replacement was evaluated on Reoperations (matched analysis) (p=0.02). Mechanical mitral valve replacement was associated with a lower reoperation rate (p=0.02) but similar survival (p=0.4) compared to bioprosthetic valves in matched patients with mitral stenosis.
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