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Mitral valve disease: if the mitral valve is not reparable/failed repair, is bioprosthesis suitable for replacement?

University of British Columbia, Vancouver, Canada

Received 5 March 2008; received in revised form 5 August 2008; accepted 22 August 2008.

^_* Corresponding author. Address: 486 Burrard Building, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6. Tel.: +1 604 806 8383; fax: +1 604 806 8384. (Email: eric.jamieson{at}ubc.ca).

Objective: The durability of mitral bioprostheses has long been known to be inferior to aortic bioprostheses. Mitral valve reconstruction/repair is currently recommended for most mitral valve procedures. The choice of prostheses for non-reparable or failed mitral valve repairs has not been specified or given appropriate attention within the literature. The objective of this study is to address the role of bioprostheses in the specific subset of non-reparable or failed repair patients by using the knowledge of the general durability of mitral porcine bioprostheses, inclusive of the Carpentier-Edwards mitral porcine bioprosthesis. Methods: The CE-SAV was implanted in 1135 patients (1175 operations) for mitral valve replacement (MVR) from 1982 to 2000. The mean age was 65.0 ± 12.1 years (range 13–86 years). The mean follow-up was 6.4 ± 4.5 years, 7555.9 patient-years and 98.3% complete. The evaluation considered freedom from structural valve deterioration (SVD) and freedom from composites of complications, as well as risk assessment. Results: For the 51–60 year age group, the actual and actuarial freedom from SVD was, at 18 years, 56.0 ± 4.1% and 14.7 ± 5.8%; for the 61–70 year age group was, at 18 years, 69.6 ± 2.6% and 26.5 ± 5.9%, respectively. For the >70 group, at 15 years was 92.2 ± 2.0% and 69.0 ± 9.7%, respectively. There were a total of 256 SVD events with 31 fatalities and 226 reoperations with 10 fatalities (4.42%). The predictors of SVD were age (hazard ratio [HR] 0.98, p = 0.0002), concomitant CAB (HR 0.66, p = 0.020) and valve size (HR 1.08, p = 0.034). The overall actual freedom, at 15–18 years, for >70 age group was, for valve-related reoperation, 94.3 ± 1.5%; and for valve-related mortality was 87.8 ± 2.3%. Conclusions: The CE-SAV mitral porcine bioprosthesis cannot be recommended as representative of prosthesis-type of choice for non-reparable or failed repair of native mitral valves for ages 70 years. The CE-SAV mitral porcine bioprosthesis is satisfactory for implantation >70 years of age. The clinical performance of the CE-SAV is similar to other mitral bioprostheses.

Key Words: Valve disease • Mitral valve