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Follow-up of isolated mitral valve prosthesis, 1964-86
1Division of Cardiology, Soroka Medical Center, Beer Sheva, Israel.
Abstract:
We review the data of 141 patients who underwent mitral valve replacement between 1964 and 1986. In the majority of patients, a tilting disk or a Cage ball prosthesis was implanted. Overall operative mortality was 14.8%, and 120 patients who were followed for a mean period of 4.5 +/- 2 years (540 patient years) showed a late mortality (greater than 30 days postoperatively) of 20.8%. The actuarial survival was 84% at 5 years and 44% at 20 years. Most of the late deaths were cardiac related, with sudden death as the leading cause. The incidence of prosthetic valve-related complications--thromboembolism, bacterial endocarditis and warfarin-related hemorrhage--were higher than in other series; however, long-term survival was comparable. Delay in advising mitral valve surgery is the probable cause of some of the results observed in this series.
Insights
Mitral valve replacement using tilting disk or caged ball prostheses had high operative and late mortality. Despite complications, long-term survival was comparable to other studies, suggesting delayed surgery may impact outcomes.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Clinical Outcomes
Background:
- Mitral valve replacement is a critical procedure for severe mitral valve disease.
- Early prosthetic valves, including tilting disk and caged ball types, were widely used.
- Understanding long-term outcomes and complications is essential for patient management.
Purpose of the Study:
- To evaluate the long-term outcomes of mitral valve replacement.
- To assess operative and late mortality rates.
- To analyze prosthetic valve-related complications and survival in patients receiving specific prosthesis types.
Main Methods:
- Retrospective review of 141 patients undergoing mitral valve replacement between 1964 and 1986.
- Analysis of operative mortality and late mortality (beyond 30 days postoperatively).
- Follow-up data for 120 patients over a mean of 4.5 years (540 patient-years) to determine actuarial survival and complication incidence.
Main Results:
- Overall operative mortality was 14.8%.
- Late mortality was 20.8%, with sudden cardiac death being the leading cause.
- Actuarial survival was 84% at 5 years and 44% at 20 years.
- Higher incidence of thromboembolism, endocarditis, and hemorrhage compared to other series.
- Long-term survival remained comparable despite increased complication rates.
Conclusions:
- Mitral valve replacement with early prostheses had significant operative and late mortality.
- Prosthetic valve complications were notable but did not preclude comparable long-term survival.
- Delayed surgical intervention is a probable contributing factor to observed outcomes in this cohort.