Survival and long-term outcomes after mitral valve replacement in patients aged 18 to 50 years.

Publisher: Mosby Country of Publication: United States NLM ID: 0376343 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-685X (Electronic) Linking ISSN: 00225223 NLM ISO Abbreviation: J Thorac Cardiovasc Surg Subsets: MEDLINE

Publication: St. Louis, MO : Mosby
Original Publication: St. Louis.

Heart Valve Prosthesis Implantation*/adverse effects ; Heart Valve Prosthesis Implantation*/methods ; Heart Valve Prosthesis Implantation*/mortality ; Hemorrhage*/epidemiology ; Hemorrhage*/etiology ; Mitral Valve*/pathology ; Mitral Valve*/surgery ; Stroke*/epidemiology ; Stroke*/etiology; Long Term Adverse Effects/*epidemiology ; Postoperative Complications/*epidemiology; Adult ; Age Factors ; Bioprosthesis/adverse effects ; Bioprosthesis/statistics & numerical data ; California/epidemiology ; Female ; Follow-Up Studies ; Heart Valve Prosthesis/adverse effects ; Heart Valve Prosthesis/statistics & numerical data ; Humans ; Incidence ; Male ; Middle Aged ; New York City/epidemiology ; Outcome and Process Assessment, Health Care ; Prosthesis Design ; Survival Analysis

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.
(Copyright © 2017. Published by Elsevier Inc.)

Comment in: J Thorac Cardiovasc Surg. 2018 Jan;155(1):103-104. (PMID: 29042102)
Comment in: J Thorac Cardiovasc Surg. 2018 Jan;155(1):79. (PMID: 29245211)

Keywords: long-term outcomes; mitral valve; mitral valve replacement; nonelderly patients; prosthetic valve choice

Date Created: 20170926 Date Completed: 20190918 Latest Revision: 20191210

20221213

10.1016/j.jtcvs.2017.08.018

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