Mitral valve replacement: indications, choice of valve prosthesis, results, and long-term morbidity of porcine and mechanical valves.

Indications for specific valve types, whether they be mechanical or bioprosthetic, have been rigorously defined in recent years. Candidates for bioprosthetic valves would be: older patients, patients who are noncompliant or have contraindications to anticoagulation, patients in normal sinus rhythm, and young females desirous of future pregnancy. Recent data suggest that patient age and presence of coronary artery disease may significantly alter the indications for mechanical or tissue valves. There is mounting evidence that patients without coronary disease in their 60s and 70s who require valve replacement are better served with a mechanical prosthesis. At Emory University Hospitals, 440 patients operated upon between 1974 and 1981 were followed for a mean period of 8.3 years. No patients having coronary artery disease were included in the cohort. Survival at 10 years was 64%. The actuarial freedom from all major valve related complications at the end of 10 years is compared to other series. Data suggests that patient survival for mitral valve replacement is affected by the etiology of the valve disease necessitating the operation. The best survival occurs in patients in whom the mitral valve replacement is for myxoid degeneration and may explain the excellent survival to be expected for mitral valve repair and concomitant coronary bypass. The most significant factor increasing morbidity and mortality in patients with mitral valve replacement and coronary artery disease is high end-diastolic pressure associated with significant depression of regional wall motion.(ABSTRACT TRUNCATED AT 250 WORDS)