Short- and long-term results of mitral valve replacement by caged-ball and bileaflet mechanical prosthesis (series of 236 consecutive patients with average follow-up of 11 years)

• Published in: Annales de cardiologie et d'angeiologie Vol. 58; no. 2; p. 86
• Main Authors: Zouaoui, W, Ouldzein, H, Drissa, M A, Essafi, N, Meddeb, I, Drissa, H
• Format: Journal Article
• Language: French
• Published: France 01-04-2009
• Subjects: Adult; Female; Follow-Up Studies; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve - surgery; Prosthesis Design; Retrospective Studies; Time Factors; Treatment Outcome
• ISSN: 1768-3181
• DOI: 10.1016/j.ancard.2008.05.011

To study the early and late results of mitral valve replacement (MVR) by Starr-Edwards caged-ball and bileaflet mechanical prosthesis.
We retrospectively analyzed 236 MVR performed in 236 patients: 127 by Starr-Edwards prosthesis (group 1) and 109 by bileaflet prosthesis (group 2).
During the early period (30 days), the mortality rate was higher in group 1 (6.3% vs 1.8%; p=0.0001), while hemorrhagic, thromboembolic and infectious complications were comparable in the two groups. In the late period (>30 days) and with an average follow-up of 11.5+/-5.7 years, mortality was higher in group 1 (9.4% vs 4.6%; p<0.0001). The same was true for thromboembolic complications (20.8% vs 6.4%; p<0.0001), hemorrhagic complications (13.4% vs 7.3%; p=0.02), infectious complications (3.1% vs 0.9%; p=0.02) and cardiac complications that were not due to the prosthesis (32.3% vs 14.7 %; p=0.02). The hemodynamic profile of the bileaflet prostheses was better than that of the Starr-Edwards prostheses (average functional prosthetic surface area was 2.37+/-0.44 cm(2) and average pressure gradient was 5.6+/-1.1 mmHg vs 2.04+/-0.52 cm(2) and 7.6+/-4.9 mmHg).
Our work confirms the superiority of bileaflet mechanical prostheses, with rates of early and late mortality, thromboembolic and hemorrhagic complications lower than those of the Starr-Edwards prostheses in more than 11 years of follow-up. However, one should not forget that the prevention of infective endocarditis, good observance of oral anticoagulant treatment and early surgery before left ventricular dysfunction occurs remain the best guarantee a good result of the MVR.