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Considerations for prostheses choice in multiple valve surgery
Ahmad Poostizadeh1, W R Eric Jamieson2, A Ian Munro1
1Department of Surgery, Vancouver Coastal Health Research Institute, University of British Columbia, 2635 (6TH Floor) 2635 Laurel St., Vancouver, BC, V5Z1M9, Canada.
Journal of Cardiothoracic Surgery
|September 17, 2021
Summary
Mechanical prostheses (MP) show better long-term outcomes in multiple valve surgery compared to bioprostheses (BP). MP use is associated with lower valve-related mortality and reoperation rates, suggesting improved clinical performance for these complex cardiac procedures.
Area of Science:
- Cardiovascular Surgery
- Prosthetic Valve Technology
- Clinical Outcomes Research
Background:
- The optimal prosthesis type for multiple valve surgery remains under-evaluated.
- Multiple valve surgery involves replacing or repairing two or more heart valves.
- Comparing bioprostheses (BP) and mechanical prostheses (MP) is crucial for patient management.
Purpose of the Study:
- To assess and compare the clinical performance of bioprostheses (BP) and mechanical prostheses (MP) in multiple valve surgery.
- To evaluate differences in patient survival and valve-related complications between BP and MP.
- To identify predictors of mortality and valve-related events in patients undergoing multiple valve surgery.
Main Methods:
- A retrospective analysis of 1245 patients undergoing multiple valve surgery between 1975 and 2000.
- Patients were divided into two groups: bioprostheses (BP, n=785) and mechanical prostheses (MP, n=460).
- Long-term follow-up data were analyzed to compare survival rates and valve-related complications, with independent predictors identified for mortality and complications.
Main Results:
- Age-adjusted survival at 12 years was similar between BP (48.7%) and MP (54.4%).
- Freedom from valve-related mortality at 12 years was significantly higher with MP (91.0%) compared to BP (85.6%).
- Freedom from valve-related reoperation at 12 years was substantially better with MP (85.6%) than BP (60.8%).
Conclusions:
- Mechanical prostheses (MP) demonstrate superior long-term outcomes in multiple valve surgery compared to bioprostheses (BP).
- MP use is associated with significantly lower rates of valve-related mortality and reoperation.
- The findings suggest a preference for mechanical prostheses in multiple valve surgery to improve patient survival and reduce complications.
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