Mitral valve replacement for mitral stenosis: A 15-year single center experience.
OBJECTIVE
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).


CONCLUSIONS
MMV replacement in mitral stenosis patients is associated with a lower reoperation rate, but there was no difference in survival compared with BMV replacement.
King Saud bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, aSaudi Arabia.
Alqasem F
AF
Al Mosa
King Saud bin Abdulaziz University for Health Sciences, Medical Education, Riyadh, bSaudi Arabia.
Aamir
A
Omair
Cardiac Clinical Research, Cardiac Surgery, Cardiac Sciences, King Abdulaziz Cardiac Center, Ministry of National Guard, Riyadh, cSaudi Arabia.
Ahmed A
AA
Arifi
Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave/M41, Cleveland, Ohio, 44195, dUnited States.
Hani K
HK
Najm
Bioprosthetic valves; Mechanical valves; Mitral stenosis; Outcome; Valve replacement
Hunan Yi Ke Da Xue Xue Bao. 2002 Feb 28;27(1):49-50
12575235
Res Cardiovasc Med. 2013 Feb;2(1):55-61
25478491
Heart. 2003 Jul;89(7):715-21
12807838
Mayo Clin Proc. 1987 Jan;62(1):22-34
3796056
Circulation. 1999 Nov 9;100(19 Suppl):II90-4
10567284
J Am Coll Cardiol. 2000 Oct;36(4):1152-8
11028464
Circulation. 2007 Sep 11;116(11 Suppl):I294-300
17846320
Eur J Cardiothorac Surg. 1996;10 (9):734-40
8905275
J Heart Valve Dis. 2000 Sep;9(5):616-22
11041173
Ann Acad Med Stetin. 1997;43:181-92
9471915
J Ayub Med Coll Abbottabad. 2010 Jan-Mar;22(1):91-6
21409914