Mitral valve replacement: long-term evaluation of prosthesis-related mortality and morbidity

Over a 12-year period isolated mitral valve replacement (MVR) was performed in 897 patients including 49 Starr-Edwards no. 6000, 519 SE no. 6120, 115 aortic allograft, and 214 porcine xenograft valves. Mortality and morbidity specifically related to the prosthesis was determined for each valve type. Fifty-two of 505 (10%) discharged patients with SE valves, four of 108 (3.7%) with homografts, no patients with heterografts, died of valve-related causes (P less than 0.05). Actuarial analysis shows continued time-related risk with any valve for both thromboemboli and valve failure. Thromboemboli were much more frequent with SE than with either tissue valve (P less than 0.05). Primary valvular incompetence was more common as a cause of valve failure with tissue valves (P less than 0.05), whereas multiple embolic episodes were more often a cause of valve failure with SE (P less than 0.05). Five of 49 (10%) patients with SE no. 6000, 30 of 519 (5.8%) with SE no. 6120, 19 of 115 (16.5%) with allografts, and two of 214 (0.9%) with xenografts needed reoperation for valve failure. For SE, homograft, and heterograft valves, actuarially determined composite, prosthesis-related mortality show 14% (80/568), 7% (8/115), 0% patients dead 6 years after MVR, respectively (P less than 0.05), while 3 years after MVR, 65% (369/568), 37% (42/115), and 85% (181/214) patients were free of prosthesis-related death or complications, respectively (P less than 0.05). Specific prosthesis-related complications differ between valve types significantly affecting survival and morbidity post-MVR.