title: [Short- and long-term results of mitral valve replacement by caged-ball and bileaflet mechanical prosthesis (series of 236 consecutive patients with average follow-up of 11 years)].
abstract: OBJECTIVE
  To study the early and late results of mitral valve replacement (MVR) by Starr-Edwards caged-ball and bileaflet mechanical prosthesis.
  
  
  METHODS
  We retrospectively analyzed 236 MVR performed in 236 patients: 127 by Starr-Edwards prosthesis (group 1) and 109 by bileaflet prosthesis (group 2).
  
  
  RESULTS
  During the early period (30 days), the mortality rate was higher in group 1 (6.3% vs 1.8%; p=0.0001), while hemorrhagic, thromboembolic and infectious complications were comparable in the two groups. In the late period (>30 days) and with an average follow-up of 11.5+/-5.7 years, mortality was higher in group 1 (9.4% vs 4.6%; p<0.0001). The same was true for thromboembolic complications (20.8% vs 6.4%; p<0.0001), hemorrhagic complications (13.4% vs 7.3%; p=0.02), infectious complications (3.1% vs 0.9%; p=0.02) and cardiac complications that were not due to the prosthesis (32.3% vs 14.7 %; p=0.02). The hemodynamic profile of the bileaflet prostheses was better than that of the Starr-Edwards prostheses (average functional prosthetic surface area was 2.37+/-0.44 cm(2) and average pressure gradient was 5.6+/-1.1 mmHg vs 2.04+/-0.52 cm(2) and 7.6+/-4.9 mmHg).
  
  
  CONCLUSIONS
  Our work confirms the superiority of bileaflet mechanical prostheses, with rates of early and late mortality, thromboembolic and hemorrhagic complications lower than those of the Starr-Edwards prostheses in more than 11 years of follow-up. However, one should not forget that the prevention of infective endocarditis, good observance of oral anticoagulant treatment and early surgery before left ventricular dysfunction occurs remain the best guarantee a good result of the MVR.
authors.affiliation: Service de cardiologie B, hôpital de Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse cedex 9, France.
authors.forename: W
authors.initials: W
authors.lastname: Zouaoui
authors.forename: H
authors.initials: H
authors.lastname: Ouldzein
authors.forename: M A
authors.initials: MA
authors.lastname: Drissa
authors.forename: N
authors.initials: N
authors.lastname: Essafi
authors.forename: I
authors.initials: I
authors.lastname: Meddeb
authors.forename: H
authors.initials: H
authors.lastname: Drissa
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011474:Prosthesis Design; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome