Prosthetic Choice in Mitral Valve Replacement for Severe Chronic Ischemic Mitral Regurgitation: Long-term follow-up

ABSTRACT Background Prosthetic choice for mitral valve replacement (MVR) is generally driven by patient’s age and patient and surgeon preference, and current guidelines do not discriminate between different etiologies of mitral valve (MV) disease. Our objective was to assess and compare short and long-term outcomes after MVR among patients with biological (BP) or mechanical (MP) prostheses in the setting of severe ischemic mitral regurgitation (IMR). Methods Between 2000 and 2016, 424 patients underwent MVR for severe IMR at our institution, using BP in 188 (44%), and MP in 236 (56%). A 1:1 propensity score match (PSM) (n=126 per group) and an inverse propensity treatment weighting (IPTW) were used to compare groups. Short-term outcomes included in-hospital mortality and other cardiovascular adverse events. Long-term outcomes included survival and hospital readmission for cardiovascular causes, stroke and major bleeding. Results In-hospital mortality and early postoperative adverse events were similar between groups in the PSM and IPTW cohort. Overall long-term survival was similar at 5 and 10 years, but MP were more frequently re-admitted to hospital for cardiovascular causes including stroke and non-neurological bleeding in PSM and IPTW analyses (all p Conclusions The type of prosthesis has no impact on long-term survival among patients with severe IMR undergoing MVR. There may be an increased risk of neurologic events and serious bleeding associated with mechanical prostheses.