Using tissue mitral valves in younger patients: A word of caution.

Autor: Arafat AA; Department of Adult Cardiac Surgery, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia.; Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt., AlQattan H; Cardiac Sciences Department, College of Medicine, King Fahad Cardiac Centre, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia., Zahra A; Department of Adult Cardiac Surgery, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia.; Cardiothoracic Surgery Department, Shbeen Elkom Teaching Hospital, Shbeen Elkom, Egypt., Alghamdi R; Department of Adult Cardiac Surgery, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia., Alghosoon H; Cardiac Research Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia., AlGhamdi F; Cardiac Sciences Department, College of Medicine, King Fahad Cardiac Centre, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia., Alamro S; Cardiac Sciences Department, College of Medicine, King Fahad Cardiac Centre, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia., Albackr H; Cardiac Sciences Department, College of Medicine, King Fahad Cardiac Centre, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia., Ismail H; Department of Adult Cardiac Surgery, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia., Adam AI; Department of Adult Cardiac Surgery, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia., Algarni KD; Cardiac Surgery Department, Johns Hopkins Aramco Hospital, Dhahran, Saudi Arabia., Albacker TB; Cardiac Sciences Department, College of Medicine, King Fahad Cardiac Centre, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
Jazyk: angličtina
Zdroj: Journal of cardiac surgery [J Card Surg] 2022 Dec; Vol. 37 (12), pp. 4227-4233. Date of Electronic Publication: 2022 Aug 30.
DOI: 10.1111/jocs.16881
Abstrakt: Background: The debate about the optimal mitral valve prosthesis continues. We aimed to compare the early and late outcomes, including stroke, bleeding, survival, and reoperation after isolated mitral valve replacement (MVR) using tissue versus mechanical valves.
Methods: This retrospective cohort study included 291 patients who had isolated MVR from 2005 to 2015. Patients were grouped into the tissue valve group (n = 140) and the mechanical valve group (n = 151).
Results: There were no differences in duration of mechanical ventilation, hospital stay, and hospital mortality between groups. Fifteen patients required cardiac rehospitalization, nine in the tissue valve group, and six in the mechanical valve group (p = .44). Stroke occurred in nine patients, five with tissue valves, and four with mechanical valves (p = .66). Bleeding occurred in 22 patients, seven patients with tissue valves, and 15 patients with mechanical valves (p = .09). Freedom from reoperation was 95%, 93%, 84%, 67% at 3, 5, 7, and 10 years for tissue valve and 97%, 96%, 96%, and 93% for mechanical valves, respectively (p˂ .001). The median follow-up was 84 months (Q1: Q3: 38-139). Survival at 3, 5, 7, and 10 years was 94%, 91%, 89%, 86% in tissue valves and 96%, 93%, 91%, 91% in mechanical valves, respectively (p = .49).
Conclusions: Tissue valve degeneration is still an issue even in the new generations of mitral tissue valves. The significant risk of reoperation in patients with mitral tissue valves should be considered when using those valves in younger patients. Mechanical valves remain a valid option for all age groups.
(© 2022 Wiley Periodicals LLC.)
Databáze: MEDLINE
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