Long-Term Performance of Mechanical and Biological Prostheses in Young Rheumatics aged below 45 years undergoing Combined Mitral and Aortic Valve Replacements: A Propensity-Matched Study

Abstract

Background and Aim: We compared 23-year composites of valve-related reoperation, morbidity, and mortality following combined mitral and aortic mechanical and bioprostheses in young rheumatics aged <45years. Methods: Retrospective comparative analysis of valve-related reoperations and survival data were performed from 498 consecutive propensity matched patients undergoing either bioprosthetic MVR (Group I, n=249) or mechanical MVR (Group II, n=249) between 1998 and 2022. Results: The median age was 33 (IQR: 27-40) and 33 (IQR: 28-39) years for Group I and II respectively. The median follow-up was 134 months (IQR: 99.5-178.5) with 5281.8 patient-years data in both biological and mechanical arm. Bioprosthetic arm exhibited lesser cumulative mortality (3.6% vs 4.8%, SMD= -0.18, p=0.01). Hazard regression for mortality included (HR, 95% CI) included preoperative CHF on inotropes and ventilator 9.84 (4.54, 18.64), p<0.001, renal failure requiring peritoneal/hemodialysis 11.64, (6.57, 20.64), p<0.001, atrial fibrillation 3.83 (1.63, 8.98), p<0.002, reoperation for thrombosed mechanical and degenerated bioprostheses 5.38, (3.09, 9.35), p<0.001, previous operation 3.53, (1.93, 6.45), p<0.001, poor left ventricular function 4.25, (2.29, 7.88), p<0.001, prolonged aortic clamp time 3.84, (2.19, 6.78), p<0.001, and prolonged CPB time 2.69, (1.84, 8.68), p<0.001. Propensity score matching did not exhibit any difference in reoperation between two groups (Group I vs Group II: 13.6% vs 17.6%, SMD= -0.110, p=0.21). At a median follow-up of 134 months (IQR: 99.5-178.5) months, actuarial survival was 92.3%±0.02% (group I vs 96.6%+0.01%) and there was no difference between the groups (p=0.90). Conclusions: Bioprostheses are an acceptable alternative to mechanical prostheses in young rheumatics aged <45 years undergoing mitral and aortic valve replacements unwilling for mechanical valve, redo surgeries, life-long anticoagulation, and those desirous of pregnancy.