Survival After Mechanical vs Biological Mitral Valve Replacement: Influence of Age vs Operative Mortality Score.

BACKGROUND: Although predicted risk of operative mortality (PROM) varies among patients, current guidelines favor bioprostheses for patients aged over 65 or 70 years. We compared survival after biological vs mechanical mitral valve replacement (MVR), and analyzed the effect of valve type on survival according to age vs PROM. METHODS: From 1983 to 2020, 2092 consecutive patients undergoing isolated MVR were enrolled. Hazard ratios for survival between mechanical versus bioprostheses were compared as a function of age and PROM using Cox proportional hazards risk adjustment. Either inverse propensity weighting or propensity matching was used to further adjust for differences between biological vs mechanical groups. RESULTS: In all inverse propensity weighted patients, PROM significantly interacted with the survival advantage of mechanical valves (P = .004). Mechanical valves were associated with significant survival advantage at age 50 years for PROM under 9%, at age 63 years for PROM under 5%, and at age 70 years for PROM under 3%. There was no significant mortality advantage for mechanical patients for STS PROM over 9% at any age or over age 70 years at any PROM. CONCLUSIONS: Contrary to some guidelines, mechanical MVR showed significant survival benefit in patients up to age 70 years with low PROM, but survival benefit was not significant for PROM 9% or more at any age. Valve selection should be individualized considering both patient age and PROM in addition to other factors.

Duke Scholars

Author Carmelo Alessio Milano Surgery, Cardiovascular and Thoracic Surgery

Author Donald D. Glower Jr. Surgery, Cardiovascular and Thoracic Surgery

Author Jeffrey Giles Gaca Surgery, Cardiovascular and Thoracic Surgery

Author Brittany Anne Zwischenberger Surgery, Cardiovascular and Thoracic Surgery