Key result
Four mechanical mitral valve prostheses show similar rates of major adverse events and survival.
Why the study?
There is no consensus regarding mitral valve management during surgical ventricular restoration for ischemic cardiomyopathy, necessitating comparison of repair versus replacement outcomes.
Cohort (n=431)
No
Answers are grounded in this paper and cite their sources.
No differences among these valves; leaves open optimal mechanical mitral prosthesis selection pending randomized trials.
There is no consensus regarding mitral valve management during surgical ventricular restoration (SVR) for ischemic cardiomyopathy. We compared the impact of SVR with mitral valve repair (MVr) vs replacement (MVR) on postoperative outcomes and long-term survival in ischemic cardiomyopathy and mitral regurgitation patients. This study included 112 patients who underwent SVR from 2009 to 2018 with MVr (n = 75) or MVR (n = 37). Patients who had MVR had higher Euro SCORE II, dyspnea class, a lower ejection fraction, higher pulmonary artery systolic pressure, higher grade of preoperative mitral and tricuspid regurgitation, and higher end-diastolic and end-systolic diameters. Intra-aortic balloon pump was more commonly used in patients with MVR. Hospital mortality occurred in 7 (9.33%) patients in the MVr group vs 3 (8.11%) in the MVR group (P > .99). Freedom from rehospitalization at 1, 5, and 7 years was 87%, 76%, and 70% in the MVr group and 83%, 61%, and 52% in the MVR group (P = .191). Survival at 1, 5, and 7 years was 88%, 78%, and 74% in the MVr group and 88%, 56%, and 56% in the MVR group (P = .027). Adjusted survival did not differ between groups.MVr or MVR are valid options in patients undergoing SVR, with good long-term outcomes.
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Arafat et al. (2023) conducted a cohort in Mitral valve disease requiring mechanical valve replacement (n=431). Type of bileaflet mechanical mitral valve prosthesis (Carbomedics, Bicarbon, ATS, On-X) vs. Other mechanical mitral valve prostheses in the cohort was evaluated on Composite endpoint of major adverse events (valve thrombosis, reoperation, stroke, pulmonary embolism, and major bleeding). There were no statistically significant differences in the composite endpoint of major adverse events or overall survival among the Carbomedics, Bicarbon, ATS, and On-X mechanical mitral valve prostheses over a median follow-up of 62 months.
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