479 Patient outcome after MVR with mechanical or bioprostheses: Do the benefits of a bioprosthesis outweigh the reoperation risk?

Abstract

BackgroundAortic valve replacement using the microsimulation modelling was previously published Although results of MVR with different valve prostheses are well documented in terms of survival, patient life-time risks of (valve related) events are less well explored. We used a large primary dataset of 2661 patients who received isolated MVR with either a bioprosthesis (56%) or a mechanical prosthesis (44%) between 1982-2003 to simulate outcome of patients after MVR with either valve type.MethodsData on postoperative and long-term survival were collected and analyzed. Using microsimulation we compared total age and gender-specific life-expectancy (LE), event-free life-expectancy (EFLE), reoperation-free life-expectancy (RFLE), and life-time risks of reoperation and valve related events between both valve types.ResultsTotal follow-up was 17,923 patient-years. Mean follow-up was 6.1 years in the biological and 7.6 years in the mechanical arm. Mean age was 67 and 59 years for the biological and mechanical groups respectively, and concomitant CABG 48% and 33%. For a 67 year old male (mean age in biological group) LE, EFLE and RFLE for biological versus mechanical prostheses were respectively 9.2 vs 9.1; 7.1 vs 7.0; 7.8 vs 8.7. Life-time risk of reoperation was 30.7% vs 6.7%.ConclusionMicrosimulation provides new insight into patient life-time risks of complications after MVR with different valve prosthesis types: even for patients in their early seventies, RFLE is better with a mechanical prosthesis, while LE and EFLE remain comparable. These data suggest the threshold for replacing the mitral valve by a mechanical prosthesis instead of a bioprosthesis should be at a higher age than is currently recommended. BackgroundAortic valve replacement using the microsimulation modelling was previously published Although results of MVR with different valve prostheses are well documented in terms of survival, patient life-time risks of (valve related) events are less well explored. We used a large primary dataset of 2661 patients who received isolated MVR with either a bioprosthesis (56%) or a mechanical prosthesis (44%) between 1982-2003 to simulate outcome of patients after MVR with either valve type. Aortic valve replacement using the microsimulation modelling was previously published Although results of MVR with different valve prostheses are well documented in terms of survival, patient life-time risks of (valve related) events are less well explored. We used a large primary dataset of 2661 patients who received isolated MVR with either a bioprosthesis (56%) or a mechanical prosthesis (44%) between 1982-2003 to simulate outcome of patients after MVR with either valve type. MethodsData on postoperative and long-term survival were collected and analyzed. Using microsimulation we compared total age and gender-specific life-expectancy (LE), event-free life-expectancy (EFLE), reoperation-free life-expectancy (RFLE), and life-time risks of reoperation and valve related events between both valve types. Data on postoperative and long-term survival were collected and analyzed. Using microsimulation we compared total age and gender-specific life-expectancy (LE), event-free life-expectancy (EFLE), reoperation-free life-expectancy (RFLE), and life-time risks of reoperation and valve related events between both valve types. ResultsTotal follow-up was 17,923 patient-years. Mean follow-up was 6.1 years in the biological and 7.6 years in the mechanical arm. Mean age was 67 and 59 years for the biological and mechanical groups respectively, and concomitant CABG 48% and 33%. For a 67 year old male (mean age in biological group) LE, EFLE and RFLE for biological versus mechanical prostheses were respectively 9.2 vs 9.1; 7.1 vs 7.0; 7.8 vs 8.7. Life-time risk of reoperation was 30.7% vs 6.7%. Total follow-up was 17,923 patient-years. Mean follow-up was 6.1 years in the biological and 7.6 years in the mechanical arm. Mean age was 67 and 59 years for the biological and mechanical groups respectively, and concomitant CABG 48% and 33%. For a 67 year old male (mean age in biological group) LE, EFLE and RFLE for biological versus mechanical prostheses were respectively 9.2 vs 9.1; 7.1 vs 7.0; 7.8 vs 8.7. Life-time risk of reoperation was 30.7% vs 6.7%. ConclusionMicrosimulation provides new insight into patient life-time risks of complications after MVR with different valve prosthesis types: even for patients in their early seventies, RFLE is better with a mechanical prosthesis, while LE and EFLE remain comparable. These data suggest the threshold for replacing the mitral valve by a mechanical prosthesis instead of a bioprosthesis should be at a higher age than is currently recommended. Microsimulation provides new insight into patient life-time risks of complications after MVR with different valve prosthesis types: even for patients in their early seventies, RFLE is better with a mechanical prosthesis, while LE and EFLE remain comparable. These data suggest the threshold for replacing the mitral valve by a mechanical prosthesis instead of a bioprosthesis should be at a higher age than is currently recommended.