JTCVS open · 2026
The choice of mitral valve surgery type and mid-term outcomes in patients up to 70 years of age: Results of the AUTHEARTVISIT study.
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Auer Johann, Florian Alissa, Wagenlechner Christine, Reichardt Berthold, Wendt Ralph, Mildner Michael, Mascherbauer Julia, Zimpfer Daniel, Ankersmit Hendrik Jan, Graf Alexandra
Аннотация
OBJECTIVE: Mitral valve replacement is indicated when mitral valve repair is not feasible. Prosthesis choice remains controversial, especially in patients aged less than 70 years, and despite existing guidelines, all too often even in those aged less than 65 years. This study investigated long-term survival and adverse outcomes after mechanical mitral valve replacement versus biological mitral valve replacement in a nationwide Austrian cohort, also including mitral valve repair as the control group.
METHODS: We performed a retrospective cohort study using Austrian insurance data. It included 3520 patients aged 70 years or less who underwent mitral heart valve surgery between January 1, 2010, and December 31, 2020. The primary end point was all-cause death; secondary end points included time to major adverse cardiac and cerebrovascular events, reoperation, myocardial infarction, heart failure, stroke, intracerebral hemorrhage, and bleeding other than intracerebral hemorrhage. These were analyzed via time-to-event analysis, including Cox proportional hazards regression and cause-specific hazards with inverse probability of treatment weighting, adjusting for demographic and clinically relevant confounders.
RESULTS: Among 3520 patients, 413 underwent mechanical mitral valve replacement, 487 underwent biological mitral valve replacement, and 2620 underwent mitral valve repair. Estimated 10-year survival was 71.6% after mechanical mitral valve replacement, 63.2% after biological mitral valve replacement, and 75.9% after mitral valve repair. Compared with mechanical mitral valve replacement, biological mitral valve replacement was associated with a higher risk of death beyond 4 years (adjusted hazard ratio, 1.94, 95% CI, 1.11-3.39, P = .02) and reduced reoperation-free survival (adjusted hazard ratio, 2.10, 95% CI, 1.24-3.56, P = .006). Early outcomes showed no significant differences.
CONCLUSIONS: In patients aged 70 years or less undergoing mitral valve replacement, mechanical mitral valve replacement provides superior long-term survival compared with biological mitral valve replacement. These findings may support mechanical valves as the preferred option in patients aged less than 70 years.
METHODS: We performed a retrospective cohort study using Austrian insurance data. It included 3520 patients aged 70 years or less who underwent mitral heart valve surgery between January 1, 2010, and December 31, 2020. The primary end point was all-cause death; secondary end points included time to major adverse cardiac and cerebrovascular events, reoperation, myocardial infarction, heart failure, stroke, intracerebral hemorrhage, and bleeding other than intracerebral hemorrhage. These were analyzed via time-to-event analysis, including Cox proportional hazards regression and cause-specific hazards with inverse probability of treatment weighting, adjusting for demographic and clinically relevant confounders.
RESULTS: Among 3520 patients, 413 underwent mechanical mitral valve replacement, 487 underwent biological mitral valve replacement, and 2620 underwent mitral valve repair. Estimated 10-year survival was 71.6% after mechanical mitral valve replacement, 63.2% after biological mitral valve replacement, and 75.9% after mitral valve repair. Compared with mechanical mitral valve replacement, biological mitral valve replacement was associated with a higher risk of death beyond 4 years (adjusted hazard ratio, 1.94, 95% CI, 1.11-3.39, P = .02) and reduced reoperation-free survival (adjusted hazard ratio, 2.10, 95% CI, 1.24-3.56, P = .006). Early outcomes showed no significant differences.
CONCLUSIONS: In patients aged 70 years or less undergoing mitral valve replacement, mechanical mitral valve replacement provides superior long-term survival compared with biological mitral valve replacement. These findings may support mechanical valves as the preferred option in patients aged less than 70 years.