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[Long-term performance of mitral valve bioprosthesis]
L K von Segesser1, R Enz, E Bauer
1Klinik für Herzgefässchirurgie, Universitätsspital Zürich.
Insights
Long-term mitral bioprosthesis implantation shows significant risks. After 11 years, only 35% of patients remain free of complications like valve deterioration or death, with 50% requiring reoperation.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Outcomes Research
Context:
- Mitral valve disease necessitates prosthetic replacement.
- Bioprosthetic valves offer an alternative to mechanical options.
- Long-term durability and complication rates are critical for patient management.
Purpose:
- To evaluate the long-term clinical performance and complication rates of mitral bioprostheses.
- To provide actuarial data on survival, thromboembolism, endocarditis, valve deterioration, and reoperation.
- To inform clinical decision-making regarding mitral valve repair versus replacement.
Summary:
- A 13-year study analyzed 250 patients receiving mitral bioprostheses, with a mean follow-up of 71 months.
- Key complications included late mortality (2.0%/patient-year), thromboembolism (1.4%/patient-year), endocarditis (1.0%/patient-year), and structural valve deterioration (3.0%/patient-year).
- Reoperation rates were 3.4%/patient-year, with 11-year actuarial freedom from complications at 35% and freedom from reoperation at 50%.
Impact:
- Findings highlight the substantial long-term risks associated with mitral bioprostheses, particularly structural valve deterioration and the need for reoperation.
- The data underscores the importance of patient selection and ongoing monitoring for complications.
- This research contributes to the understanding of bioprosthetic valve longevity and informs future device development and clinical guidelines.
Abstract:
Long-term clinical performance of mitral tissue valves was analyzed in a consecutive series of 250 patients (131 men, 118 women; mean age 51 years) over a 13-year period. Mean follow-up was 71 months (range 1-141 months). The total cumulative follow-up period was 1466 years. The late mortality was 2.0% per patient-year, whereas thromboembolism occurred in 1.4% per patient-year, prosthetic valve endocarditis in 1.0% per patient-year, periprosthetic leaks in 0.3% per patient-year and structural valve deterioration in 3.0% per patient-year. The rate of reoperation was 3.4% per patient-year. Actuarial analysis showed the following results (1 year/5 years/10 years): Survival rate: 97 +/- 1%/89 +/- 2%/82 +/- 5%; free of embolisms: 98 +/- 1%/96 +/- 1%/86 +/- 5%; free of endocarditis: 99 +/- 1%/95 +/- 2%/90 +/- 3%; free of valve deterioration: 99 +/- 1%/96 +/- 1%/60 +/- 8%; no reoperation: 98 +/- 1%/94 +/- 2%/57 +/- 8%; free of late complications: 92 +/- 2%/77 +/- 4%/41 +/- 10%. On the basis of our statistical evaluation the probabilities are that, 11 years after implantation of a mitral bioprosthesis: (a) only 35% of patients are free of late complications (including thromboembolisms, prosthetic valve endocarditis, structural valve deterioration and death); (b) and only 50% of patients have not needed reoperation.