Outcome comparison of mitral valve disease patients aged 50 to 65 undergoing mechanical <i>versus</i> tissue prosthesis implantation: A propensity-score matched study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FAN Fudong , TANG Xinlong , ZHOU Qing , PAN Jun , CAO Hailong , XUE Yunxing ,  WANG Dongjin

Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing Medical University, Nanjing, 210008, P.R.China;

Corresponding author：

WANG Dongjin, Email: njglwdj@126.com

Keywords：

Mitral valve replacement; biological valve; mechanical valve; prognosis; propensity-score matched study

DOI：

10.7507/1007-4848.202008032

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Objective To evaluate the in-hospital and long-term outcomes of patients receiving mitral valve replacement with mechanical or biological prosthesis.Methods The clinical data of patients undergoing mitral valve replacement in our center between January 2005 and August 2018 were retrospectively analyzed. Patients with emergency, reoperation, bleeding or embolic events or incomplete clinical data were ruled out.Results Totally 569 patients were enrolled, including 325 with mechanical prosthesis (a mechanical prosthesis group, 111 males and 214 females with a mean age of 55.54±4.09 years) and 244 bioprosthesis (a bioprosthesis group, 90 males and 154 females with a mean age of 60.02±4.28 years). There was no significant difference in the in-hospital mortality between the two groups (P=0.250). The survival rate at postoperative 15 years of the bioprosthesis group was higher than that of mechanical prosthesis group (78.69% vs. 66.25%, χ²=8.844, P=0.003). No remarkable differences were found in prosthesis failure (P=0.183) and thromboembolism events (P=0.505) between the two groups. Bleeding occurred more frequently in the mechanical prosthesis group (P=0.040). After the propensity-score matched analysis based on the age, the survival rate was still higher in the bioprosthesis group than in the mechanical prosthesis group (P=0.032).Conclusion Biological prosthesis can be considered as the preferable choice in mitral valve replacement procedure in order to improve the long-term survival and decrease the frequent of bleeding events.

1.	Falk V, Baumgartner H, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg, 2017, 52(4): 616-664.
2.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A Report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation, 2017, 135(25): e1159-e1195.
3.	Weber A, Noureddine H, Englberger L, et al. Ten-year comparison of pericardial tissue valves versus mechanical prostheses for aortic valve replacement in patients younger than 60 years of age. J Thorac Cardiovasc Surg, 2012, 144(5): 1075-1083.
4.	Wang Y, Chen S, Shi J, et al. Mid- to long-term outcome comparison of the Medtronic HancockⅡand bi-leaflet mechanical aortic valve replacement in patients younger than 60 years of age: a propensity-matched analysis. Interact Cardiovasc Thorac Surg, 2016, 22(3): 280-286.
5.	Diaz R, Hernandez-Vaquero D, Alvarez-Cabo R, et al. Long-term outcomes of mechanical versus biological aortic valve prosthesis: Systematic review and meta-analysis. J Thorac Cardiovasc Surg, 2019, 158(3): 706-714.
6.	Hanania G. Which heart valve prosthesis for patients aged between 60 and 70 years? Heart, 2003, 89(5): 481-482.
7.	Ribeiro A, Wender O, de Almeida A, et al. Comparison of clinical outcomes in patients undergoing mitral valve replacement with mechanical or biological substitutes: a 20 years cohort. BMC Cardiovasc Disord, 2014, 14: 146.
8.	Cen YY, Glower DD, Landolfo K, et al. Comparison of survival after mitral valve replacement with biologic and mechanical valves in 1139 patients. J Thorac Cardiovasc Surg, 2001, 122(3): 569-577.
9.	Cetinkaya A, Poggenpohl J, Bramlage K, et al. Long-term outcome after mitral valve replacement using biological versus mechanical valves. J Cardiothorac Surg, 2019, 14(1): 120.
10.	Hammermeister K, Sethi GK, Henderson WG, et al. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J Am Coll Cardiol, 2000, 36(4): 1152-1158.
11.	朱思明, 姜胜利. 60~70 岁患者二尖瓣机械瓣与生物瓣置换术后疗效的对比观察. 解放军医学杂志, 2017, 42(5): 468-471.
12.	McClure RS, McGurk S, Cevasco M, et al. Late outcomes comparison of nonelderly patients with stented bioprosthetic and mechanical valves in the aortic position: a propensity-matched analysis. J Thorac Cardiovasc Surg, 2014, 148(5): 1931-1939.
13.	Reineke DC, Heinisch PP, Winkler B, et al. Mitral valve replacement in patients under 65 years of age: mechanical or biological valves? Curr Opin Cardiol, 2015, 30(2): 146-150.
14.	江文. 理性选择机械瓣膜和生物瓣膜. 中国胸心血管外科临床杂志, 2015, 22(4): 361-365.
15.	Sundt TM, Schaff HV, Soltesz EG, et al. Mechanical vs biologic valves: Our modern day conundrum. Semin Thorac Cardiovasc Surg, 2016 Summer, 28(2): 404-417.

1. Falk V, Baumgartner H, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg, 2017, 52(4): 616-664.
2. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A Report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation, 2017, 135(25): e1159-e1195.
3. Weber A, Noureddine H, Englberger L, et al. Ten-year comparison of pericardial tissue valves versus mechanical prostheses for aortic valve replacement in patients younger than 60 years of age. J Thorac Cardiovasc Surg, 2012, 144(5): 1075-1083.
4. Wang Y, Chen S, Shi J, et al. Mid- to long-term outcome comparison of the Medtronic HancockⅡand bi-leaflet mechanical aortic valve replacement in patients younger than 60 years of age: a propensity-matched analysis. Interact Cardiovasc Thorac Surg, 2016, 22(3): 280-286.
5. Diaz R, Hernandez-Vaquero D, Alvarez-Cabo R, et al. Long-term outcomes of mechanical versus biological aortic valve prosthesis: Systematic review and meta-analysis. J Thorac Cardiovasc Surg, 2019, 158(3): 706-714.
6. Hanania G. Which heart valve prosthesis for patients aged between 60 and 70 years? Heart, 2003, 89(5): 481-482.
7. Ribeiro A, Wender O, de Almeida A, et al. Comparison of clinical outcomes in patients undergoing mitral valve replacement with mechanical or biological substitutes: a 20 years cohort. BMC Cardiovasc Disord, 2014, 14: 146.
8. Cen YY, Glower DD, Landolfo K, et al. Comparison of survival after mitral valve replacement with biologic and mechanical valves in 1139 patients. J Thorac Cardiovasc Surg, 2001, 122(3): 569-577.
9. Cetinkaya A, Poggenpohl J, Bramlage K, et al. Long-term outcome after mitral valve replacement using biological versus mechanical valves. J Cardiothorac Surg, 2019, 14(1): 120.
10. Hammermeister K, Sethi GK, Henderson WG, et al. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J Am Coll Cardiol, 2000, 36(4): 1152-1158.
11. 朱思明, 姜胜利. 60~70 岁患者二尖瓣机械瓣与生物瓣置换术后疗效的对比观察. 解放军医学杂志, 2017, 42(5): 468-471.
12. McClure RS, McGurk S, Cevasco M, et al. Late outcomes comparison of nonelderly patients with stented bioprosthetic and mechanical valves in the aortic position: a propensity-matched analysis. J Thorac Cardiovasc Surg, 2014, 148(5): 1931-1939.
13. Reineke DC, Heinisch PP, Winkler B, et al. Mitral valve replacement in patients under 65 years of age: mechanical or biological valves? Curr Opin Cardiol, 2015, 30(2): 146-150.
14. 江文. 理性选择机械瓣膜和生物瓣膜. 中国胸心血管外科临床杂志, 2015, 22(4): 361-365.
15. Sundt TM, Schaff HV, Soltesz EG, et al. Mechanical vs biologic valves: Our modern day conundrum. Semin Thorac Cardiovasc Surg, 2016 Summer, 28(2): 404-417.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesOutcome comparison of mitral valve disease patients aged 50 to 65 undergoing mechanical versus tissue prosthesis implantation: A propensity-score matched study

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