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Isolated mitral valve replacement. With Carpentier-Edwards bioprosthesis :independent risk factors for long-term
H H Kimose1, O Lund, B Ljungström
1Department of Thoracic and Cardiovascular Surgery, Skejby Sygehus, Aarhus University Hospital, Denmark.
Insights
This study identifies key preoperative factors predicting survival and complications after Carpentier-Edwards porcine bioprosthesis mitral valve replacement. A prognostic index was developed to stratify patients into distinct risk groups for better outcomes.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Epidemiology
Background:
- Mitral valve disease necessitates surgical intervention, with bioprosthetic valves offering a common solution.
- The Carpentier-Edwards porcine bioprosthesis (CEPB) has been utilized for mitral valve replacement, but long-term outcomes require careful prediction.
- Preoperative patient characteristics significantly influence the success and complication rates of valve replacement surgery.
Purpose of the Study:
- To identify preoperative predictors of long-term survival following mitral valve replacement with CEPB.
- To examine the predictability of prosthesis-related complications.
- To develop a prognostic index for stratifying patient risk.
Main Methods:
- Retrospective analysis of 188 patients undergoing CEPB for isolated mitral valve disease between 1976 and 1986.
- Cox regression analysis was employed to determine independent predictors of survival and complications.
- A prognostic index was calculated based on significant preoperative variables.
Main Results:
- Five preoperative factors independently predicted long-term survival: myxomatous degeneration, chronic regurgitation, age, NYHA class III-IV, and atrial flutter/fibrillation.
- A prognostic index stratified patients into six risk groups with significantly different 10-year survival rates (p < 0.0001).
- Incidence rates for late complications included hemorrhage (1.2%/patient-years), thromboembolism (0.5%/patient-years), endocarditis (1.0%/patient-years), paravalvular leak (0.2%/patient-years), and primary tissue failure (1.5%/patient-years).
Conclusions:
- Preoperative assessment is crucial for predicting outcomes in patients undergoing CEPB mitral valve replacement.
- The developed prognostic index effectively categorizes patients into distinct risk strata, aiding in clinical decision-making.
- Understanding predictors of complications like hemorrhage, endocarditis, and tissue failure can guide preventative strategies.
Abstract:
From 1976 through 1986, 188 patients (female/male ratio: 2/1, age 20-77 years, mean 58 years) with isolated mitral valve disease underwent valve replacement using the Carpentier-Edwards porcine bioprothesis (CEPB). Nine hospital deaths (4.8%) were excluded from further analysis. Follow-up was 0.2-11.3 years (mean 5.2 years); preoperatively, 74% had atrial flutter/fibrillation, and 75% were in NYHA-classes III-IV. All patients were put on life-long coumadin treatment. Preoperative predictability of long-term survival and prosthesis-related complications was examined using Cox regression analysis. Five preoperative variables were found to have independent predictive value as regards long-term survival: myxomatous degeneration of the valve (p = 0.002), chronic regurgitation (p = 0.003), age (p = 0.004), NYHA-class III-IV (p = 0.05), and atrial flutter/fibrillation (p = 0.05). A prognostic index calculated form the final Cox model identified six risk groups (I-VI) having cumulative 10-year survivals +/- SE of: I (n = 9) 100%, II (n = 10) 90 +/- 9%, III (n = 30) 73 +/- 10%, IV (n = 70) 51 +/- 9%, V (n = 43) 17 +/- 10%, and VI (n = 17, 7-year survival) 16 +/- 13% (p less than 0.0001). The incidence of late valve-related complications (%/patient-years) were: hemorrhage, 1.2; thromboembolism, 0.5; Endocarditis, 1.0; paravalvular leak, 0.2; and primary tissue failure, 1.5. Previous closed comissurotomy adversely influenced the occurrence of hemorrhage, while calcified mitral annulus were predictive of endocarditis. Younger age (less than or equal to 45 years) had a strong predictive influence of primary tissue failure.(ABSTRACT TRUNCATED AT 250 WORDS)