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

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original paper
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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.