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Very-long-term outcomes of mechanical valves in mitral position focusing on valve-related complications

OBJECTIVES: This study aimed to examine very-long-term outcomes of a mechanical valve at the mitral position. METHODS: This study included all patients who underwent mitral valve replacement (MVR) using a mechanical valve including urgent operation at the Department of Cardiovascular Surgery, Hyogo...

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Autores principales: Uchino, Gaku, Murakami, Hirohisa, Mukohara, Nobuhiko, Tanaka, Hiroshi, Nomura, Yoshikatsu, Miyahara, Shunsuke, Kawashima, Motoharu, Fujisue, Jun, Tonoki, Shuto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9297525/
https://www.ncbi.nlm.nih.gov/pubmed/35640541
http://dx.doi.org/10.1093/icvts/ivac146
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author Uchino, Gaku
Murakami, Hirohisa
Mukohara, Nobuhiko
Tanaka, Hiroshi
Nomura, Yoshikatsu
Miyahara, Shunsuke
Kawashima, Motoharu
Fujisue, Jun
Tonoki, Shuto
author_facet Uchino, Gaku
Murakami, Hirohisa
Mukohara, Nobuhiko
Tanaka, Hiroshi
Nomura, Yoshikatsu
Miyahara, Shunsuke
Kawashima, Motoharu
Fujisue, Jun
Tonoki, Shuto
author_sort Uchino, Gaku
collection PubMed
description OBJECTIVES: This study aimed to examine very-long-term outcomes of a mechanical valve at the mitral position. METHODS: This study included all patients who underwent mitral valve replacement (MVR) using a mechanical valve including urgent operation at the Department of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, from January 1987 to December 2015. RESULTS: Five hundred and eighty-three patients (277 men [47.51%]; age, 61 [54–67] years) were included in this study. The implanted valve models were as follows: SJM, 221 (37.91%); ATS, 35 (6.00%); On-X, 68 (11.66%); and Carbomedics 194, (33.28%).The median clinical follow-up duration was 13.3 (7.4–19.6) years. The survival rates at 10, 15, 20 and 25 years were 81.42%, 69.27%, 56.34% and 45.03%, respectively. Thromboembolism was observed in 38 patients, and the linearized ratio for each event was 0.626%/patient-year [95% confidence interval (CI), 0.443–0.859%]. Intracranial haemorrhage and gastrointestinal bleeding were observed in 26 and 9 patients, and the linearized ratio for each event was 0.425%/patient-year (95% CI, 0.277–0.006%) and 0.145%/patient-year (95% CI, 0.067–0.276%), respectively. Major paravalvular leak was observed in 32 patients, and the linearized ratio was 0.532%/patient-year (95% CI, 0.364%–0.751%). The cumulative incidence rate of major paravalvular leak at 10, 15, 20 and 25 years was 3.7%, 5.6%, 6.4% and 10.4%, respectively. Multivariable Cox regression analysis revealed that repeated MVR and male gender were associated with major paravalvular leak. CONCLUSIONS: Male gender and repeated MVR were risk factors for paravalvular leak after mechanical MVR. Paravalvular leak could have occurred regardless of postoperative period even at 25 years after implantation. Lifelong clinical follow-up is considered necessary.
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spelling pubmed-92975252022-07-21 Very-long-term outcomes of mechanical valves in mitral position focusing on valve-related complications Uchino, Gaku Murakami, Hirohisa Mukohara, Nobuhiko Tanaka, Hiroshi Nomura, Yoshikatsu Miyahara, Shunsuke Kawashima, Motoharu Fujisue, Jun Tonoki, Shuto Interact Cardiovasc Thorac Surg Adult Cardiac OBJECTIVES: This study aimed to examine very-long-term outcomes of a mechanical valve at the mitral position. METHODS: This study included all patients who underwent mitral valve replacement (MVR) using a mechanical valve including urgent operation at the Department of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, from January 1987 to December 2015. RESULTS: Five hundred and eighty-three patients (277 men [47.51%]; age, 61 [54–67] years) were included in this study. The implanted valve models were as follows: SJM, 221 (37.91%); ATS, 35 (6.00%); On-X, 68 (11.66%); and Carbomedics 194, (33.28%).The median clinical follow-up duration was 13.3 (7.4–19.6) years. The survival rates at 10, 15, 20 and 25 years were 81.42%, 69.27%, 56.34% and 45.03%, respectively. Thromboembolism was observed in 38 patients, and the linearized ratio for each event was 0.626%/patient-year [95% confidence interval (CI), 0.443–0.859%]. Intracranial haemorrhage and gastrointestinal bleeding were observed in 26 and 9 patients, and the linearized ratio for each event was 0.425%/patient-year (95% CI, 0.277–0.006%) and 0.145%/patient-year (95% CI, 0.067–0.276%), respectively. Major paravalvular leak was observed in 32 patients, and the linearized ratio was 0.532%/patient-year (95% CI, 0.364%–0.751%). The cumulative incidence rate of major paravalvular leak at 10, 15, 20 and 25 years was 3.7%, 5.6%, 6.4% and 10.4%, respectively. Multivariable Cox regression analysis revealed that repeated MVR and male gender were associated with major paravalvular leak. CONCLUSIONS: Male gender and repeated MVR were risk factors for paravalvular leak after mechanical MVR. Paravalvular leak could have occurred regardless of postoperative period even at 25 years after implantation. Lifelong clinical follow-up is considered necessary. Oxford University Press 2022-05-30 /pmc/articles/PMC9297525/ /pubmed/35640541 http://dx.doi.org/10.1093/icvts/ivac146 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Adult Cardiac
Uchino, Gaku
Murakami, Hirohisa
Mukohara, Nobuhiko
Tanaka, Hiroshi
Nomura, Yoshikatsu
Miyahara, Shunsuke
Kawashima, Motoharu
Fujisue, Jun
Tonoki, Shuto
Very-long-term outcomes of mechanical valves in mitral position focusing on valve-related complications
title Very-long-term outcomes of mechanical valves in mitral position focusing on valve-related complications
title_full Very-long-term outcomes of mechanical valves in mitral position focusing on valve-related complications
title_fullStr Very-long-term outcomes of mechanical valves in mitral position focusing on valve-related complications
title_full_unstemmed Very-long-term outcomes of mechanical valves in mitral position focusing on valve-related complications
title_short Very-long-term outcomes of mechanical valves in mitral position focusing on valve-related complications
title_sort very-long-term outcomes of mechanical valves in mitral position focusing on valve-related complications
topic Adult Cardiac
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9297525/
https://www.ncbi.nlm.nih.gov/pubmed/35640541
http://dx.doi.org/10.1093/icvts/ivac146
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