Mitral valve replacement for mitral stenosis: A 15-year single center experience

Objectives mitral valve replacement with either a bioprosthetic or a mechanical valve is the treatment of choice for severe mitral stenosis. however,choosing a valve implant type is still a subject of debate. this study aimed to evaluate and compare the early and late outcomes of mitral valve replacement [mechanical (mmv) vs. bioprosthetic (bmv)] for severe mitral stenosis. methods a retrospective cohort study was performed on data involving mitral stenosis patients who have undergone mitral valve replacement with either bmv (n = 50) or mmv (n = 145) valves from 1999 to 2012. data were collected from the patients’ records and follow-up through telephone calls. data were analyzed for early and late mortality,new york heart association (nyha) functional classes,stroke,pre- and postoperative echocardiographic findings,early and late valve-related complications,and survival. chi-square test,logistic regression,kaplan–meier curve,and dependent proportions tests were some of the tests employed in the analysis. results a total of 195 patients were included in the study with a 30-day follow-up echocardiogram available for 190 patients (97.5%),while 103 (53%) were available for follow-up over the telephone. one patient died early postoperatively; twelve patients died late in the postoperative period,six in the bioprosthesis group and six in the mechanical group. the late mortality had a significant association with postoperative stroke (p < 0.001) and postoperative nyha classes iii and iv (p = 0.002). postoperative nyha class was significantly associated with age (p = 0.003),pulmonary disease (p = 0.02),mitral valve implant type (p = 0.01),and postoperative stroke (p = 0.02); 14 patients had strokes in the mechanical (9) and in the bioprosthetic (5) groups. nyha classes were significantly better after the replacement surgeries (p < 0.001). bmv were significantly associated with worse survival (p = 0.03),worse nyha postoperatively (p = 0.01),and more reoperations (p = 0.006). survival was significantly better with mmv (p = 0.03). when the two groups were matched for age and mitral regurgitation,the analysis revealed that bmv were significantly associated with reoperations (p = 0.02) but not significantly associated with worse survival (p = 0.4) or worse nyha (p = 0.4). conclusion mmv replacement in mitral stenosis patients is associated with a lower reoperation rate,but there was no difference in survival compared with bmv replacement. © 2016