Key result
Early postoperative NYHA class ≥III independently predicts higher risk of bioprosthetic mitral valve dysfunction.
Why the study?
Although guidelines recommend bioprosthetic mitral valve replacement (MVRb) for patients aged 70 and older, an increasing number of younger patients (≤ 70 years) are undergoing the procedure. Early postoperative prognostic markers associated with subsequent bioprosthetic mitral valve dysfunction in this younger population needed to be identified.
Do early postoperative clinical and echocardiographic markers predict subsequent bioprosthetic mitral valve dysfunction in patients aged ≤ 70 years undergoing bioprosthetic mitral valve replacement?
Cohort (n=238)
Single-blind
No
Do early postoperative clinical and echocardiographic markers predict subsequent bioprosthetic mitral valve dysfunction in patients aged ≤ 70 years undergoing bioprosthetic mitral valve replacement?
In patients aged ≤ 70 years undergoing bioprosthetic mitral valve replacement, early postoperative advanced NYHA class, elevated PASP, higher mean transmitral gradient, and reduced effective orifice area independently predict subsequent valve dysfunction.
Answers are grounded in this paper and cite their sources.
Early postoperative markers may stratify MVD risk after bioprosthetic MVR in patients ≤70 years; leaves open need for prospective validation before guiding surveillance.
Background Although guidelines recommend bioprosthetic mitral valve replacement (MVRb) for patients aged 70 and older, an increasing number of younger patients (≤ 70 years) are undergoing MVRb due to specific clinical indications. This study aims to identify early postoperative prognostic markers associated with subsequent bioprosthetic mitral valve dysfunction (MVD) in patients ≤ 70 years who underwent MVRb. Methods This retrospective study included 238 patients aged ≤ 70 years who underwent MVRb between January 2009 and December 2022. MVD was defined by new or progressive prosthetic morphological abnormalities with haemodynamic deterioration from the 1–3-month postoperative reference examination. LASSO-selected variables were entered into a multivariable cause-specific Cox model and incorporated into a nomogram. Internal validation used 1,000 selection-aware bootstrap resamples, and nomogram-based risk groups were compared using competing-risk analysis. Results During a median echocardiographic follow-up of 166.2 months (IQR, 77.8–175.5 months), MVD occurred in 64 of 238 patients. NYHA functional class ≥ III (HR, 1.89; 95% CI, 1.13–3.17), PASP per 10 mmHg (HR, 1.93; 95% CI, 1.44–2.59), mean transmitral gradient per 1 mmHg (HR, 1.31; 95% CI, 1.16–1.49), and EOA per 0.5 cm² (HR, 0.51; 95% CI, 0.38–0.68) were independently associated with MVD (all P ≤ 0.05). Results were consistent in sensitivity analyses. The nomogram showed good internal discrimination, with an optimism-corrected C-index of 0.791 (95% CI, 0.740–0.840), with corrected AUCs of 0.842 and 0.809 at 7 and 10 years, respectively. Risk groups showed significantly different cumulative incidences of MVD (Gray’s P < 0.001). Conclusions Key prognostic markers for MVD in younger patients who underwent MVRb include advanced NYHA class, elevated PASP, higher MG and reduced EOA. The nomogram may aid postoperative risk stratification, but external validation is required before clinical application.
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Huang et al. (2026) conducted a cohort in Bioprosthetic mitral valve replacement (n=238). Early postoperative NYHA functional class ≥ III (along with PASP, mean transmitral gradient, and EOA) vs. NYHA functional class I-II was evaluated on Bioprosthetic mitral valve dysfunction (MVD) (HR 1.89, 95% CI 1.13-3.17, p=0.015). Early postoperative NYHA class ≥III (HR 1.89), PASP per 10 mmHg (HR 1.93), mean gradient per 1 mmHg (HR 1.31), and EOA per 0.5 cm² (HR 0.51) independently predicted bioprosthetic MVD.
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