Mitral Valve Bioprosthesis Is Safer Than Mechanical Mitral Prosthesis in Young Women
DOI:
https://doi.org/10.1532/hsf.3145Keywords:
cardiac valve prostheses, mitral valve replacement, biological valve, mechanical valveAbstract
Background: The ultimate goal of mitral valve surgery in young women is to extend life expectancy and improve quality of life. Mitral valve replacement (MVR) prosthesis in middle-aged women is a difficult choice between the lifelong anticoagulation by mechanical prosthesis versus the limited long-term durability of bioprosthesis. The current trend towards reducing women’s age for selecting bioprosthesis over mechanical prosthesis leads to a dilemma for younger women decision making. The aim of this study was to compare the safety and freedom from complications in pregnancy and survival rate after mitral valve bioprosthesis versus mechanical prosthesis in young women for whom mitral valve repair is not feasible, or unsuitable.
Methods: This single-center non randomized prospective study included all female patients undergoing MVR at our center from January 2010 to February 2020.
Results: In total, 355 young women patients underwent MVR at our center, of whom 174 received a bioprosthesis and 181 received a mechanical prosthesis. The use of anticoagulation among young women with mechanical prosthesis was associated with a remarkable risk of postoperative bleeding, abortion, and increased frequency of pregnancy-related complications (P < .0001). In contrast, there was a considerable survival benefit for those who received bioprosthesis
(P = .0001).
Conclusion: Our data confirm that the use of mitral bioprosthesis in young women who desire to become pregnant is safe, reduces complications, and increases survival.
References
Applegate PM, Boyd WD, Applegate li RL, Liu H. 2017. Is it the time to reconsider the choice of valves for cardiac surgery: mechanical or bioprosthetic? J Biomed Res 31:373-6.
Batra J, Itagaki S, Egorova NN, Chikwe J. 2018. Outcomes and long-term effects of pregnancy in women with biologic and mechanical valve prostheses. Am J Cardiol 122:1738-44.
Castillo JG, Solís J, González-Pinto A, Adams DH. 2011. Surgical echocardiography of the mitral valve. Rev Esp Cardiol 64:1169-81.
Chikwe J, Chiang YP, Egorova NN, Itagaki S, Adams DH. 2015. Survival and outcomes following bioprosthetic vs mechanical mitral valve replacement in patients aged 50 to 69 years. JAMA 313:1435-42.
Cunanan CM, Cabiling CM, Dinh TT, et al. 2001. Tissue characterization and calcification potential of commercial bioprosthetic heart valves. Ann Thorac Surg 71:417-21.
Fine JP, Gray RJ. 1999. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94:496-509.
Fino C, Iacovoni A, Pibarot P, et al. 2018. Exercise hemodynamic and functional capacity after mitral valve replacement in patients with ischemic mitral regurgitation: a comparison of mechanical versus biological prostheses. Circ Heart Fail 11:e004056.
Frater RW, Furlong P, Cosgrove DM, et al. 1998. Long-term durability and patient functional status of the Carpentier-Edwards Perimount pericardial bioprosthesis in the aortic position. J Heart Valve Dis 7:48-53.
Gammie JS, Sheng S, Griffith BP, et al. 2009. Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Database. Ann Thorac Surg 87:1431-9.
Hui C, Lili M, Libin C, et al. 2012. Changes in coagulation and hemodynamics during pregnancy: a prospective longitudinal study of 58 cases. Arch Gynecol Obstet 285:1231-6.
Iung B, Rodes-Cabau J. 2014. The optimal management of anti-thrombotic therapy after valve replacement: certainties and uncertainties. Eur Heart J 35:2942-9.
Kaneko T, Aranki S, Javed Q, et al. 2014. Mechanical versus bioprosthetic mitral valve replacement in patients<65 years old. J Thorac Cardiovasc Surg 147:117-26.
Kulik A, Bédard P, Lam BK, et al. 2006. Mechanical versus bioprosthetic valve replacement in middle-aged patients. Eur J Cardiothorac Surg 30:485-91.
Kyriacou DN, Lewis RJ. 2016. Confounding by indication in clinical research. JAMA 316:1818-19.
Nishimura RA, Otto CM, Bonow RO, et al. 2014. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 129:2440-92.
Rahimtoola SH. 2010. Choice of prosthetic heart valve in adults. Am Coll Cardiol 55:2413-26.
Sordelli C, Severino S, Ascione L, Coppolino P, Caso P. 2014. Echocardiographic assessment of heart valve prostheses. J Cardiovasc Echogr 24:103-13.
Tillquist MN, Maddox TM. 2011. Cardiac crossroads: deciding between mechanical or bioprosthetic heart valve replacement. Patient Prefer Adherence 5:91-9.
Walfisch A, Koren G. 2010. The "warfarin window" in pregnancy: the importance of half-life. J Obstet Gynaecol Can 32:988‐9.
Wang Y, Chen S, Shi J, Li G, Dong N. 2015. Mid- to long-term outcome comparison of the Medtronic Hancock II and bi-leaflet mechanical aortic valve replacement in patients younger than 60 years of age: a propensity-matched analysis. Interact Cardiovasc Thorac Surg 22:1-7.
Woo YJ, Greene CL. 2016. Prosthetic valve choice in middle-aged patients: guidelines and other guiding principles. Eur J Cardiothorac Surg 49:1468-9.
