Samuel R Schnittman1, Shinobu Itagaki1, Nana Toyoda1, David H Adams1, Natalia N Egorova2, Joanna Chikwe3. 1. Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY. 2. Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, NY. 3. Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Surgery, Stony Brook University Hospital, New York, NY. Electronic address: Joanna.Chikwe@mountsinai.org.
Abstract
OBJECTIVE: To provide long-term data on survival and major morbidity after mitral valve replacement in patients aged 18 to 50 years. METHODS: Retrospective analysis of 2727 patients aged 18 to 50 years who underwent isolated mitral replacement in California and New York from 1997 to 2006. Median follow-up time was 12.4 years (maximum 15.0 years). The primary endpoint was mortality; secondary endopoints were stroke, major bleeding, and reoperation. Propensity matching yielded 373 patient pairs. RESULTS: Bioprosthetic valve use increased from 10% to 34% between 1997 and 2014 (P < .001). Among propensity score-matched patients, actuarial 15-year survival was 74.3% (95% confidence interval [CI], 69.0%-78.7%) after bioprosthetic versus 80.8% (95% CI, 75.1%-85.3%) mechanical valve replacement (hazard ratio [HR], 1.67; 95% CI, 1.21-2.32, P = .002). At 15 years after mitral valve replacement, the cumulative incidence of stroke was similar (9.1% [95% CI, 6.0%-13.0%] vs 9.7% [95% CI, 6.7-13.4]; HR, 0.95 [95% CI, 0.57-1.59]); the cumulative incidence of major bleeding events was similar (7.9% [95% CI, 5.0%-11.5%] vs 11.5% [95% CI, 7.6%-16.2%]; HR, 0.78 [95% CI, 0.46-1.32]); and the cumulative incidence of reoperation after bioprosthetic valve replacement was greater (19.9% [95% CI, 15.4%-24.8%] vs 5.7% [95% CI, 3.5%-8.7%]; HR, 20.3 [95% CI, 4.0-102.8]), respectively. CONCLUSIONS: The significant survival benefit associated with mechanical mitral valve replacement in adults ≤50 years may be due to the practice of implanting bioprostheses in sicker patients or those judged less likely to comply with long-term medication despite adjustment for baseline characteristics in propensity score matching.
OBJECTIVE: To provide long-term data on survival and major morbidity after mitral valve replacement in patients aged 18 to 50 years. METHODS: Retrospective analysis of 2727 patients aged 18 to 50 years who underwent isolated mitral replacement in California and New York from 1997 to 2006. Median follow-up time was 12.4 years (maximum 15.0 years). The primary endpoint was mortality; secondary endopoints were stroke, major bleeding, and reoperation. Propensity matching yielded 373 patient pairs. RESULTS: Bioprosthetic valve use increased from 10% to 34% between 1997 and 2014 (P < .001). Among propensity score-matched patients, actuarial 15-year survival was 74.3% (95% confidence interval [CI], 69.0%-78.7%) after bioprosthetic versus 80.8% (95% CI, 75.1%-85.3%) mechanical valve replacement (hazard ratio [HR], 1.67; 95% CI, 1.21-2.32, P = .002). At 15 years after mitral valve replacement, the cumulative incidence of stroke was similar (9.1% [95% CI, 6.0%-13.0%] vs 9.7% [95% CI, 6.7-13.4]; HR, 0.95 [95% CI, 0.57-1.59]); the cumulative incidence of major bleeding events was similar (7.9% [95% CI, 5.0%-11.5%] vs 11.5% [95% CI, 7.6%-16.2%]; HR, 0.78 [95% CI, 0.46-1.32]); and the cumulative incidence of reoperation after bioprosthetic valve replacement was greater (19.9% [95% CI, 15.4%-24.8%] vs 5.7% [95% CI, 3.5%-8.7%]; HR, 20.3 [95% CI, 4.0-102.8]), respectively. CONCLUSIONS: The significant survival benefit associated with mechanical mitral valve replacement in adults ≤50 years may be due to the practice of implanting bioprostheses in sicker patients or those judged less likely to comply with long-term medication despite adjustment for baseline characteristics in propensity score matching.
Authors: Sadie Bennett; Jacopo Tafuro; Marcus Brumpton; Caragh Bardolia; Grant Heatlie; Simon Duckett; Paul Ridley; Prakash Nanjaiah; Chun Shing Kwok Journal: Echo Res Pract Date: 2022-07-13
Authors: Isaac Wamala; Axel Unbehaun; Christoph Klein; Marian Kukucka; Dirk Eggert-Doktor; Semih Buz; Julia Stein; Simon Sündermann; Volkmar Falk; Jörg Kempfert Journal: Interact Cardiovasc Thorac Surg Date: 2021-05-10