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Ann Thorac Surg 1990;49:643-648
© 1990 The Society of Thoracic Surgeons

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Articles

Determinants of survival and valve failure after mitral valve replacement

Division of Cardiovascular Surgery, The Toronto General Hospital The University of Toronto, Toronto, Ontario, Canada

Accepted for publication December 14, 1989.

^_* Address reprint requests to Dr Weisel, Cardiovascular Surgery, Toronto General Hospital, 200 Elizabeth St, Eaton North 13-224, Toronto, Ont M2G 2C3, Canada.

A prospective evaluation of 333 consecutive patients undergoing isolated mitral valve replacement between 1982 and 1985 was performed to identify the predictors of survival and valve failure. Follow-up between 2 and 6 years postoperatively (mean, 32 ± 17 months) was 98% complete. Four prostheses were inserted to permit a prospective evaluation of alternative valves: Björk-Shiley mechanical (n = 118), Ionescu-Shiley pericardial (n = 146), Carpentier-Edwards porcine (n = 38), and Hancock pericardial (n = 31). Hospital mortality was 6%, and actuarial survival at 5 years was 71% ± 5%. Multivariate Cox regression analysis identified advancing age (<40 yean, 88% ± 7%; >70 years, 50% ± 14%) and poor left ventricular function (ejection fraction <0.20, 62% ± 17%; ejection fraction >0.60, 80% ± 7%) as independent predictors of postoperative survival. Freedom from structural valve dysfunction, prosthetic valve endocarditis, reoperation, and valve-related mortality and morbidity were 86% ± 4%, 91% ± 4%, 81% ± 4%, and 72% ± 5%, respectively, at 5 years. The actuarial incidence of valve failure was inordinately high with the Hancock pericardial valve (p < 0.05). Freedom from thromboembolic events (78% ± at 5 years) was significantly lower in patients with poor ventricular function (ejection fraction <0.20, 54% ± 20%; ejection fraction >0.60, 73% ± 11%; p < 0.05). Survival after mitral valve replacement was determined by age and left ventricular function. Premature failure of the Hancock pericardial valve resulted in an unacceptable rate of valve-related complications.

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