Long-term performance of prostheses in mitral valve replacement.

The long-term performance of prostheses in mitral valve replacement (MVR) is now available with representatives of current generation prostheses to 15 years. Mechanical prostheses have been implanted for 33 years and bioprostheses for 22 years. The predominant complication of mechanical prostheses is hemorrhage from anticoagulation and reoperation for late structural valve deterioration of bioprostheses. Mitral valve (MV) reconstruction, over MVR, is recommended whenever possible, especially with the advancement of atrial fibrillation ablation techniques. The current indications for MVR are those valvular lesions that are unlikely to be repaired by most surgeons or which long-term results are suboptimal with reconstruction. Reconstruction is more common for degenerative disease, replacement for rheumatic disease and variable for advanced ischemic and infective disease. The recommendations for MVR for mitral stenosis (MS) are moderate to severe MS with advanced functional status and severe pulmonary hypertension when percutaneous balloon valvotomy or mitral reconstruction is not feasible. MVR is recommended in non-ischemic severe mitral regurgitation (MR) and for non-reparable acute symptomatic MR, advanced symptomatic status, systolic dysfunction and/or ventricular dysfunction. The recommendations for MV surgery in ischemic MR are acute post-infarction MR with cardiogenic shock, unstable angina with persistent moderate-severe and severe MR and chronic, dilated ischemic cardiomyopathy with moderate-severe and severe MR.