HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Jamieson, W.R.E. Articles by Germann, E. Search for Related Content PubMed PubMed Citation Articles by Jamieson, W.R.E. Articles by Germann, E. Related Collections Cardiac - other Valve disease

J Thorac Cardiovasc Surg 2005;129:1301-1308
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Performance of bioprostheses and mechanical prostheses assessed by composites of valve-related complications to 15 years after mitral valve replacement

University of British Columbia, Vancouver, British Columbia, Canada.

Read at the Twenty-ninth Annual Meeting of The Western Thoracic Surgical Association, Carlsbad, Calif, June 18–21, 2003.

Received for publication June 17, 2003; revisions received September 8, 2004; accepted for publication September 22, 2004.

^_* Address for reprints: W. R. Eric Jamieson, MD, 486 Burrard Building, St Paul’s Hospital, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada. (Email: wrej{at}interchange.ubc.ca).

OBJECTIVE: Predominant concerns of patients undergoing valve replacement surgery are risks of death, stroke, antithrombotic bleeding, and reoperation related to the replacement prosthesis. The purpose of this study was to compare valve-related reoperation, morbidity (permanent impairment), and mortality between bioprostheses and mechanical prostheses for mitral valve replacement.

METHODS: Between 1982 and 1998, a total of 959 bioprostheses were implanted in 943 patients, and a total of 961 mechanical prostheses were implanted in 839 patients. Total follow-ups were 5730 years for bioprostheses and 5271 years for mechanical prostheses. Eight variables were considered as predictors of risk for the composites of valve-related complications.

RESULTS: The linearized occurrence rates for valve-related reoperation were 3.7 events/100 patient-years for bioprostheses and 0.5 events/100 patient-years for mechanical prostheses (P < .001), with all age groups differentiated except older than 70 years. Valve-related morbidity was undifferentiated for bioprostheses and mechanical prostheses. Valve-related mortalities were 1.7 events/100 patient-years for bioprostheses and 0.7 events/100 patient-years for mechanical prostheses (P < .001). Predictors of valve-related reoperation were age and valve type. The only predictor of valve-related morbidity was age, whereas age and valve type were predictors for valve-related mortality. Actual freedom from valve-related reoperation favored mechanical prostheses in all age groups except older than 70 years (91.7% ± 2.0% for bioprostheses at 15 years and 96.7% ± 1.5% at 12 years for mechanical prostheses). Actual freedom from valve-related morbidity was not different between bioprostheses and mechanical prostheses. Actual freedom from valve-related mortality favored mechanical prostheses in all groups except older than 70 years.

CONCLUSION: Comparative evaluation gives high priority in mitral valve replacement for mechanical prostheses relative to bioprostheses for freedom from valve-related reoperation and valve-related mortality but not valve-related morbidity. Freedom from valve-related reoperation and valve-related mortality favors mechanical prostheses for all age groups except older than 70 years. Valve-related morbidity, due to neurologic or functional impairments, does not differentiate between bioprostheses and mechanical prostheses.

This article has been cited by other articles:

				T. Gudbjartsson, T. Absi, and S. Aranki Mitral Valve Replacement Card. Surg. Adult, January 1, 2008; 3(2008): 1031 - 1068. [Full Text]

				M. Ruel, V. Chan, P. Bedard, A. Kulik, L. Ressler, B. K. Lam, F. D. Rubens, W. Goldstein, P. J. Hendry, R. G. Masters, et al. Very Long-Term Survival Implications of Heart Valve Replacement With Tissue Versus Mechanical Prostheses in Adults <60 Years of Age Circulation, September 11, 2007; 116(11_suppl): I-294 - I-300. [Abstract] [Full Text] [PDF]

				A. Kulik, P. Bedard, B-K. Lam, F. D. Rubens, P. J. Hendry, R. G. Masters, T. G. Mesana, and M. Ruel Mechanical versus bioprosthetic valve replacement in middle-aged patients. Eur. J. Cardiothorac. Surg., September 1, 2006; 30(3): 485 - 491. [Abstract] [Full Text] [PDF]

				V. Chan, W.R.E. Jamieson, E. Germann, F. Chan, R.T. Miyagishima, L.H. Burr, M.T. Janusz, H. Ling, and G.J. Fradet Performance of bioprostheses and mechanical prostheses assessed by composites of valve-related complications to 15 years after aortic valve replacement J. Thorac. Cardiovasc. Surg., June 1, 2006; 131(6): 1267 - 1273. [Abstract] [Full Text] [PDF]