1
|
Rokui S, Gottschalk B, Peng D, Groenewoud R, Ye J. Long-term outcomes of isolated mechanical versus bioprosthetic mitral valve replacement in different age groups of propensity-matched patients. Eur J Cardiothorac Surg 2024; 66:ezae245. [PMID: 38936344 PMCID: PMC11223803 DOI: 10.1093/ejcts/ezae245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/05/2024] [Accepted: 06/26/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVES Prothesis choice in isolated mitral valve replacement for patients aged 75 years or younger remains debated as most studies comparing prothesis type have included large proportions of combined operations and benefits are influenced by concomitant procedures. This study compared long-term outcomes of isolated mechanical versus bioprosthetic mitral valves in different age groups of propensity-matched populations. METHODS This is a retrospective, multicentre, propensity-matched observational study. Baseline characteristics, operative details and long-term outcomes (mortality and freedom from surgical/transcatheter reintervention) were collected. RESULTS Totally, 1536 isolated mitral valve replacements (806 mechanical, 730 bioprosthetic) were performed between 2000 and 2017. Over 90% of eligible patients successfully underwent propensity matching, yielding 226 each of mechanical and bioprosthetic valves in patients aged <65 years and 171 each of bioprosthetic and mechanical valves in patients aged 65-75 years with median follow-up of 13 years (maximum 20 years). In matched patients <65 years, 10-year survival was superior with mechanical valves versus bioprosthetic valves (78.2% vs 69.8%, P = 0.029), as was 10-year freedom from reintervention (96.2% vs 81.3%, P < 0.001). For matched patients between 65 and 75 years, there were no differences between mechanical and bioprosthetic valves in 10-year survival (64.6% vs 60.8%, P = 0.86) or 10-year freedom from reintervention (94.0% vs 97.2%, P = 0.23). Rates of post-operative stroke, gastrointestinal bleeding, renal failure and permanent pacemaker insertion were similar. CONCLUSIONS In patients requiring isolated mitral valve replacement, mechanical valves confer significantly better long-term survival and freedom from reintervention for patients <65 years, while no benefit is observed at age 65-75 years compared to bioprosthetic valves.
Collapse
Affiliation(s)
- Sorush Rokui
- Division of Cardiac Surgery, St Paul’s Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Byron Gottschalk
- Division of Cardiac Surgery, St Paul’s Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Defen Peng
- Division of Cardiac Surgery, St Paul’s Hospital and University of British Columbia, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Rosalind Groenewoud
- Division of Cardiac Surgery, St Paul’s Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Jian Ye
- Division of Cardiac Surgery, St Paul’s Hospital and University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
2
|
Koulouroudias M, Di Mauro M, Chiariello G, Meani P, Lorusso R. Long-Term Outcomes of Bioprosthetic Valves in the Mitral Position: A Pooled Meta-Analysis of Reconstructed Time-to-Event Individual Patient Data. Am J Cardiol 2024; 221:64-73. [PMID: 38636624 DOI: 10.1016/j.amjcard.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/21/2024] [Accepted: 04/13/2024] [Indexed: 04/20/2024]
Abstract
Bioprosthetic mitral valve replacement (bMVR) use is increasing; however, data regarding long-term durability are lacking. We sought to perform a reconstructed individual patient data meta-analysis from published Kaplan-Meier curves to ascertain survival, freedom from valve degeneration, and reoperation in studies published since 2010. We explored the effects of age and valve type (bovine pericardial or porcine valve) on outcomes. We searched MEDLINE, OVID, Embase, and Cochrane CENTRAL for studies reporting at least 3 years of follow-up after bMVR and published since 2010. The Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool was used to assess methodologic quality. Kaplan-Meier curves were digitized to extract individual patient data and reconstructed estimates for overall survival, freedom from structural valve deterioration (SVD), and freedom from reoperation. A total of 20 studies (16,465 patients) were included. A total of 9 studies reported on porcine valves, 6 reported on bovine, and 7 did not specify the valve type. The overall survival after bMVR at 15 years was 40% (confidence interval 38% to 42%), freedom from reoperation at 15 years was 79% (confidence interval 76% to 82%), and freedom from SVD at 15 years was 64% (58% to 70%). Freedom from SVD was improved in the 70+ years age group (93% up to 25 years, hazard ratio 6.6 [2.5 to 17] for 18 to 59 vs >70 years, p <0.0001). There was no difference in valve durability or survival between bovine pericardial or porcine valves. In this meta-analysis of patients who underwent bMVR using newer generation valves, the inverse relation between age and SVD was reiterated in the 70+ years age group. The prosthesis type made no difference in the outcomes.
Collapse
Affiliation(s)
- Marinos Koulouroudias
- Cardiovascular Research Institute (CARIM), University of Maastricht, Maastricht, The Netherlands; Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, United Kingdom.
| | - Michele Di Mauro
- Cardiovascular Research Institute (CARIM), University of Maastricht, Maastricht, The Netherlands; Department of Cardiology, "Pierangeli" Hospital, Pescara, Italy
| | - Giovanni Chiariello
- Cardiovascular Research Institute (CARIM), University of Maastricht, Maastricht, The Netherlands; Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic, IRCCS, Rome, Italy
| | - Paolo Meani
- Cardiovascular Research Institute (CARIM), University of Maastricht, Maastricht, The Netherlands
| | - Roberto Lorusso
- Cardiovascular Research Institute (CARIM), University of Maastricht, Maastricht, The Netherlands; Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
3
|
Ahmed A, Awad AK, Varghese KS, Sehgal VS, Hisham K, George J, Pandey R, Vega E, Polizzi M, Mathew DM. Bioprosthetic versus mechanical valves for mitral valve replacement in patients < 70 years: an updated pairwise meta-analysis. Gen Thorac Cardiovasc Surg 2024; 72:95-103. [PMID: 37414971 DOI: 10.1007/s11748-023-01956-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The ideal conduit for mitral valve replacement (MVR) remains elusive, particularly among younger patients due to increased life expectancy. We perform a pairwise meta-analysis comparing the use of bioprosthetic valves (BPV) and mechanical mitral valves (MMV) in patients < 70 years old undergoing MVR. METHODS We comprehensively searched medical databases to identify studies comparing the use of BPV and MMV in patients < 70 years old undergoing MVR. Pairwise meta-analysis was performed using the Mantel-Haenszel method in R version 4.0.2. Outcomes were pooled using the random effect model as risk ratios (RR) with their 95% confidence intervals (95% CI). RESULTS 16,879 patients from 15 studies were pooled. Compared to MMV, BPV was associated with significantly higher rates of 30-day mortality (RR 1.53, p = 0.0006) but no difference in 30-day stroke (RR 0.70, p = 0.43). At a weighted mean follow-up duration of 14.1 years, BPV was associated with higher rates of long-term mortality (RR 1.28, p = 0.0054). No difference was seen between the two groups for risk of long-term stroke (RR 0.92, p = 0.67), reoperation(RR 1.72, p = 0.12), or major-bleeding (RR 0.57, p = 0.10) at a weighted mean follow-up duration of 11.7, 11.3, and 11.9 years, respectively. CONCLUSION The use of MMV in patients < 70 undergoing MVR is associated with lower rates of 30-day/long-term mortality compared to BPV. No significant differences were observed for risk of 30-day/long-term stroke, long-term reoperation, and long-term major bleeding. These findings support the use of MMV in younger patients, although prospective, randomized trials are still needed.
Collapse
Affiliation(s)
- Adham Ahmed
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA.
| | - Ahmed K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Kathryn S Varghese
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | - Viren S Sehgal
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | - Kenzy Hisham
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Jerrin George
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Roshan Pandey
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | - Eamon Vega
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | - Mia Polizzi
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| | - Dave M Mathew
- CUNY School of Medicine, 1589 Amsterdam Avenue, New York, NY, 10031, USA
| |
Collapse
|
4
|
Koulouroudias M, Di Mauro M, Lorusso R. Long-term outcomes of bioprosthetic valves in the mitral position a systematic review of studies published over the last 20 years. Eur J Cardiothorac Surg 2023; 64:ezad384. [PMID: 37963023 DOI: 10.1093/ejcts/ezad384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/26/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES Although the use of bioprostheses for mitral valve replacement (bMVR) is on the rise, their long-term durability is not well described. Defining bMVR durability will be instrumental in setting the standard against which the performance of transcatheter mitral replacement is to be judged against. The authors of this systematic review aimed to identify, assess the quality and review the outcomes in studies reporting on long-term outcomes after bMVR published over the last 20 years. METHODS Medline, Embase and Cochrane CENTRAL were searched for studies that have reported outcomes beyond a minimum of 5 years of follow-up after bMVR. Cohort characteristics, definitions of structural valve deterioration (SVD) and outcomes were summarized. The risk of bias in included studies was assessed using the Cochrane QUIPS tool. RESULTS Twenty-one studies, including 15 833 patients, were identified. Sixty-four percent of all implants were porcine and the remaining bovine pericardial. Freedom from SVD at 10 years ranged from 58.9% to 100% and at 15 years from 58.3% to 93%. Freedom from reoperation ranged from 65% to 98.7% at 10 years and 78.5% to 91% at 15 years. Information on native valve pathology or dominant haemodynamic lesion was missing in 25% and 66% of studies, respectively. Reports of postoperative echocardiography were lacking, despite the heavy reliance on echocardiography for SVD diagnosis. CONCLUSIONS There is considerable variability in reporting bMVR long-term outcomes. As such, it is difficult to generate an unbiased, generalizable understanding of long- term outcomes after bMVR across the spectrum of mitral disease phenotypes.
Collapse
Affiliation(s)
- Marinos Koulouroudias
- Cardiovascular Research Institute, CARIM, University of Maastricht, Netherlands
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
| | - Michele Di Mauro
- Cardiovascular Research Institute, CARIM, University of Maastricht, Netherlands
| | - Roberto Lorusso
- Cardiovascular Research Institute, CARIM, University of Maastricht, Netherlands
- Heart & Vascular Centre, Maastricht University Medical Centre, Netherlands
| |
Collapse
|
5
|
Yao X, Li N, Lu R, Wang X, Zhang Y, Wang S. Development of a nomogram for predicting nosocomial infections among patients after cardiac valve replacement surgery. J Clin Nurs 2023; 32:1466-1475. [PMID: 35988041 DOI: 10.1111/jocn.16489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/14/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To construct a predictive nomogram of the risk of nosocomial infections among patients after cardiac valve replacement surgery. BACKGROUND Nosocomial infections are a standout challenge that worsens the prognosis of patients after valve replacement surgery. However, studies on the nomogram of nosocomial infections in these patients have remained scarce. DESIGN A retrospective cohort study. METHODS Patients (n = 720) following valve replacement surgery from 2018 to 2019 were selected. LASSO regression and multivariate logistic regression were utilised to ascertain predictors of nosocomial infections. The predictive performance of the nomogram was appraised by calibration and discrimination. Decision and impact curves were used to assess the clinical utility. Internal validation was implemented via 1000 bootstrap samples to mitigate overfitting. TRIPOD guidelines were used in this study. RESULTS One hundred and fifty one patients (20.97%) experienced nosocomial infections following valve replacement surgery. Heart failure, preoperative anaemia, valve material, American Society of Anesthesiologists score ≥ IV, prolonged duration of surgery, duration of mechanical ventilation ≥ 24 h and indwelling nasogastric tube were predictors of nosocomial infections. Using these variables, we developed a predictive nomogram of the occurrence of nosocomial infections and the internal validation results demonstrated good discrimination and calibration of the nomogram. The clinical decision and impact curve revealed significant clinical utility. CONCLUSIONS The present study constructed a nomogram for predicting the risk of nosocomial infections in patients following cardiac valve replacement surgery. This nomogram may strengthen the effective screening of patients at high risk of nosocomial infections. RELEVANCE TO CLINICAL PRACTICE This risk warning tool can assist clinical staff in making decisions and providing individualised infection control measures for patients, which has a significant reference value for clinical practice. NO PATIENT OR PUBLIC CONTRIBUTION The data for this study were obtained from the hospital database, and the entire process of the study did not involve patient participation.
Collapse
Affiliation(s)
- Xue Yao
- School of Nursing and Rehabilitation, Shandong University, Jinan, China.,Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, China
| | - Na Li
- School of Nursing and Rehabilitation, Shandong University, Jinan, China.,Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, China
| | - Ranran Lu
- School of Nursing and Rehabilitation, Shandong University, Jinan, China.,Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, China
| | - Xujing Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan, China.,Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, China
| | - Yujun Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan, China.,Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, China
| | - Shuhui Wang
- Department of Infection Prevention and Control, Qilu Hospital of Shandong University, Jinan, China
| |
Collapse
|
6
|
Jain A, Subramani S, Gebhardt B, Hauser J, Bailey C, Ramakrishna H. Infective Endocarditis-Update for the Perioperative Clinician. J Cardiothorac Vasc Anesth 2023; 37:637-649. [PMID: 36725476 DOI: 10.1053/j.jvca.2022.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
Infective endocarditis is a common pathology routinely encountered by perioperative physicians. There has been a need for a comprehensive review of this important topic. In this expert review, the authors discuss in detail the incidence, etiology, definition, microbiology, and trends of infective endocarditis. The authors discuss the clinical and imaging criteria for diagnosing infective endocarditis and the perioperative considerations for the same. Other imaging modalities to evaluate infective endocarditis also are discussed. Furthermore, the authors describe in detail the clinical risk scores that are used for determining clinical prognostic criteria and how they are tied to the current societal guidelines. Knowledge about native and prosthetic valve endocarditis, with emphasis on the timing of surgical intervention-focused surgical approaches and analysis of current outcomes, are critical to managing such patients, especially high-risk patients like those with heart failure, patients with intravenous drug abuse, and with internal pacemakers and defibrillators in situ. And lastly, with the advancement of percutaneous transcatheter valves becoming a norm for the management of various valvular pathologies, the authors discuss an in-depth review of transcatheter valve endocarditis with a focus on its incidence, the timing of surgical interventions, outcome data, and management of high-risk patients.
Collapse
Affiliation(s)
- Ankit Jain
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia & Augusta University, Augusta, GA
| | - Sudhakar Subramani
- Department of Anesthesiology and Perioperative Medicine, University of Iowa, Iowa City, IA
| | - Brian Gebhardt
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Memorial Medical Center, MA
| | - Joshua Hauser
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Caryl Bailey
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia & Augusta University, Augusta, GA
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
7
|
Kahrovic A, Angleitner P, Andreas M, Werner P, Russo M. Editorial commentary: Native mitral valve infective endocarditis-Surgical concerns? J Card Surg 2022; 37:3720-3721. [PMID: 36040687 PMCID: PMC9804545 DOI: 10.1111/jocs.16892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Amila Kahrovic
- Department of Cardiac SurgeryMedical University of ViennaViennaAustria
| | | | - Martin Andreas
- Department of Cardiac SurgeryMedical University of ViennaViennaAustria
| | - Paul Werner
- Department of Cardiac SurgeryMedical University of ViennaViennaAustria
| | - Marco Russo
- Department of Cardiac SurgeryMedical University of ViennaViennaAustria,Department of Cardiac Surgery and Heart TransplantationSan Camillo Forlanini Hospital of RomeRomeItaly
| |
Collapse
|
8
|
Yu J, Qiao E, Wang W. Mechanical or biologic prostheses for mitral valve replacement: A systematic review and meta-analysis. Clin Cardiol 2022; 45:701-716. [PMID: 35665516 PMCID: PMC9286334 DOI: 10.1002/clc.23854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/25/2022] [Accepted: 05/16/2022] [Indexed: 12/02/2022] Open
Abstract
Either a mechanical or bioprosthetic valve is used in patients undergoing mitral valve replacement (MVR). However, the optimal mitral prosthesis remains controversial. The aim of this meta‐analysis was thus to compare outcomes between mechanical mitral valve replacement (MVRm) and bioprosthetic mitral valve replacement (MVRb) for MVR patients. We searched Embase, PubMed, Web of Science, and Cochrane Library databases from January 1, 2000 to October 31, 2021 for studies that directly compared surgical outcomes of MVRm and MVRb. A total of 22 studies with 35 903 patients were included in the meta‐analysis (n = 23 868 MVRm and n = 12 035 MVRb). The MVRm group displayed lower long‐term all causes mortality (HR, 0.84; 95% confidence interval [CI]: 0.77−0.91; p < .0001; I² = 51%), and fewer mitral reoperation (hazard ratio [HR]: 0.34; 95% CI: 0.23−0.50; p < .00001; I² = 74%) than MVRb group. However, the MVRm group was associated with a greater risk of major bleeding events (HR: 1.21; 95% CI: 1.14−1.29; p < .00001; I² = 0%), stroke and systemic embolism (HR: 1.20; 95% CI: 1.10−1.32; p < .0001; I² = 0%) in matched or adjusted data. No significant difference was observed between MVRm and MVRb on operative mortality in matched/adjusted group (risk ratios: 0.83; 95% CI: 0.66−1.05; p = .12; I² = 0%). The results were consistent with patients aged under 70 years old. Patients who received a MVRm is associated with 16% lower risk of long‐term mortality and 66% lower risk of mitral reoperation, but 20% greater risk of stroke or systemic embolism, 21% greater risk of major bleeding compared with MVRb in matched/adjusted studies group, which were consistent to patients younger than the age of 70 years who underwent MVR.
Collapse
Affiliation(s)
- Jun Yu
- Department of Structural Heart Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - En Qiao
- Department of Structural Heart Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Wei Wang
- Department of Structural Heart Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| |
Collapse
|
9
|
Malmberg M, Anttila V, Rautava P, Gunn J, Kytö V. Long-term outcomes of mechanical versus biological valve prosthesis in native mitral valve infective endocarditis. SCAND CARDIOVASC J 2022; 56:132-137. [PMID: 35652503 DOI: 10.1080/14017431.2022.2079712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives. To study the long-term outcomes of mitral valve replacement with mechanical or biological valve prostheses in native mitral valve infective endocarditis patients. Desing. We conducted a retrospective, nationwide, multicenter cohort study with patients aged ≤70 years who were treated with mitral valve replacement for native mitral valve infective endocarditis in Finland between 2004 and 2017. Results. The endpoints were all-cause mortality, ischemic stroke, major bleeding, and mitral valve reoperations. The results were adjusted for baseline features (age, gender, comorbidities, history of drug abuse, concomitant surgeries, operational urgency, and surgical center). The median follow-up time was 6.1 years. The 12-year cumulative mortality rates were 36% for mechanical prostheses and 74% for biological prostheses (adj. HR 0.40; CI: 0.17-0.91; p = 0.03). At follow-up, the ischemic stroke had occurred in 19% of patients with mechanical prosthesis and 33% of those with a biological prosthesis (adj. p = 0.52). The major bleeding rates within the 12-year follow-up period were 30% for mechanical prosthesis and 13% for a biological prosthesis (adj. p = 0.29). The mitral valve reoperation rates were 13% for mechanical prosthesis and 12% for a biological prosthesis (adj. p = 0.50). Drug abuse history did not have a significant modifying impact on the results (interaction p = 0.51 for mortality and ≥0.13 for secondary outcomes). Conclusion. The use of mechanical mitral valve prosthesis is associated with lower long-term mortality compared to the biological prosthesis in non-elder native mitral valve infective endocarditis patients. The routine choice of biological mitral valve prostheses for this patient group is not supported by the results.
Collapse
Affiliation(s)
- Markus Malmberg
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Vesa Anttila
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Jarmo Gunn
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
10
|
Yu J, Wang W. Bioprosthetic vs. Mechanical Mitral Valve Replacement for Rheumatic Heart Disease in Patients Aged 50–70 Years. Front Cardiovasc Med 2022; 9:904958. [PMID: 35711344 PMCID: PMC9193579 DOI: 10.3389/fcvm.2022.904958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/12/2022] [Indexed: 11/21/2022] Open
Abstract
Background Rheumatic heart disease (RHD) is a critical problem in developing countries and is the cause of most of the cardiovascular adverse events in young people. In patients aged 50–70 years with RHD requiring mitral valve replacement (MVR), deciding between bioprosthetic and mechanical prosthetic valves remains controversial because few studies have defined the long-term outcomes. Methods 1,691 Patients aged 50–70 years with RHD who received mechanical mitral valve replacement (MVRm) or bioprosthetic mitral valve replacement (MVRb) were retrospectively reviewed in Fuwai hospital from 2010 to 2014. Follow-up ended 31/12/2021; median duration was 8.0 years [interquartile range (IQR), 7.7–8.3 years]. Propensity score matching at a 1:1 ratio for 24 baseline features between MVRm and MVRb yielded 300 patient pairs. The primary late outcome was postoperative mid- to long-term all-cause mortality. Results Ten-year survival after MVR was 63.4% in the MVRm group and 63.7% in the MVRb group (HR, 0.91; 95% CI, 0.69–1.21; P = 0.528). The cumulative incidence of mitral valve reoperation was 0.0% in the MVRm group and 1.2% in the MVRb group (HR, 0.92; 95% CI, 0.69–1.21; P = 0.530). The cumulative incidence of stroke was 5.5% in the MVRm group and 6.1% in the MVRb group (HR, 0.89; 95% CI, 0.67–1.18; P = 0.430). The cumulative incidence of major bleeding events was 3.3% in the MVRm group and 3.4% in the MVRb group (HR, 0.92; 95% CI, 0.70–1.22; P = 0.560). Conclusions In patients aged 50–70 years with RHD who underwent mitral valve replacement, there was no significant difference on survival, stroke, mitral valve reoperation and major bleeding events at 10 years. These findings suggest mechanical mitral valve replacement may be a more reasonable alternative in patients aged 50–70 years with rheumatic heart disease.
Collapse
|
11
|
OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6523883. [DOI: 10.1093/ejcts/ezac056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/12/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
|
12
|
Hu X, Jiang W, Xie M, Guo R, Yim WY, Dong N, Wang Y. Bioprosthetic vs mechanical mitral valve replacement for infective endocarditis in patients aged 50 to 69 years. Clin Cardiol 2020; 43:1093-1099. [PMID: 32497339 PMCID: PMC7533963 DOI: 10.1002/clc.23407] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
Background The optimal choice of the valve prosthesis in mitral valve replacement (MVR) for infective endocarditis (IE) is controversial and challenging, particularly for younger patients. Hypothesis The postoperative outcomes of mechanical and biological MVR in IE patients aged 50 to 69 years are different. Methods All IE patients aged 50 to 69 years with primary MVR in Hubei province hospitals from 2002 to 2018 were retrospectively reviewed. The median duration of follow‐up was 8.7 years (IQR, 6.8‐10.9 years). Propensity score matching (1:3 ratio) was used to yield 492 patients with comparable baseline features between bioprostheses and mechanical prosthetic valve groups. Outcomes were postoperative mid‐ to long‐ term survival, mitral valve reoperation, prosthetic valve endocarditis (PVE), stroke, and major bleeding events. Results Fifteen‐year survival after MVR was 80.6% in the mechanical valve group and 69.3% in the bioprostheses group (HR 0.545, P = .040). The cumulative incidence of mitral valve reoperation was 8.8% with mechanical valves and 21.4% with bioprostheses (HR 0.260, P = .002). The cumulative incidence of PVE was 5.6% with mechanical valves and 7.2% with bioprostheses (HR 0.629, P = .435). The cumulative incidence of stroke was 12.9% with mechanical valves and 10.5% with bioprostheses (HR 1.217, P = .647). The cumulative incidence of major bleeding was 12.0% with mechanical valves and 6.75% with bioprostheses (HR 1.579, P = .268). Conclusions Mechanical valve prostheses were associated with better survival, lower rates of reoperation compared with bioprostheses within 15 years after MVR in IE patients aged 50 to 69. These findings suggest mechanical valve prostheses may be a more reasonable alternative to bioprostheses in this patient group.
Collapse
Affiliation(s)
- Xingjian Hu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Quality Control Center of Cardiovascular Surgery, Health Committee of Hubei Province, Wuhan, China
| | - Weiwei Jiang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Minghui Xie
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruikang Guo
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wai Yen Yim
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Quality Control Center of Cardiovascular Surgery, Health Committee of Hubei Province, Wuhan, China
| | - Yin Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|