Subscribe to RSS
DOI: 10.1055/s-2006-925733
Choice of prosthesis in mitral valve replacement and concomitant coronary revascularization
Objectives: Mitral valve replacement (MVR) and concomitant coronary artery surgery (CABG) is associated with a high operative and late mortality and morbidity. This study compares patients who underwent MVR with biological or mechanical prosthesis focusing on differences in long term survival and valve related complications.
Methods: Retrospective analysis of 239 consecutive patients, who underwent primary MVR with concomitant CABG between 1974 and 2003. One hundred sixteen (48.5%) received a bioprosthesis (group B, mean age 71±7.5 years) and 123 patients (51.5%) a mechanical prosthesis (group M, mean age 63±7.6 years). The follow up is 95% complete (mean follow up of 100 survivors 5.5±4.2 years)
Results: 30-day mortality in group B was 15.5% compared to 17.1% in group M. Eighty nine patients died late after an average of 5.8±5.1 years. Ten year survival in group B and M was 34.5±7% and 40.5±5% respectively (p=0.187). Seven patients (2.9%) required a mitral valve related reoperation. Freedom from reoperation at 10 years in group B and M was 92±5.4% and 94±4% respectively (p=0.205). The incidence of thromboembolic and bleeding events was significantly lower in group B.
Conclusions: MVR with concomitant CABG carries a high operative risk and is associated with a poor long-term outcome. Mechanical and biological prostheses can be used with comparable results regarding survival. Incidence of reoperation is low. Most patients do not experience failure of their prostheses. Considering the advantage of bioprostheses regarding valve related complications such as thromboembolism and hemorrhage their use may not be limited to older patients.