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

详细信息    查看全文

• 作者：Alqasem F. Al Mosa^a ; Aamir Omair^b ; Ahmed A. Arifi^c ; Hani K. Najm^d ; ^{najmh@ccf.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Bioprosthetic valves ; Mechanical valves ; Mitral stenosis ; Outcome ; Valve replacement
• 刊名：Journal of the Saudi Heart Association
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：28
• 期：4
• 页码：232-238
• 全文大小：939 K

文摘

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.