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Ann Thorac Surg 1991;52:84-91
© 1991 The Society of Thoracic Surgeons

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Articles

Influence of type of prosthesis on late results after combined mitral-aortic valve replacement

Department of Cardiovascular Surgery, University of Padova Medical School, Padova, Italy

Accepted for publication March 1, 1991.

^_* Address reprint requests to Dr Bortolotti, Istituto di Chirurgia Cardiovascolare, Università di Padova, Via Giustiniani, 2, 35128 Padova, Italy.

The influence of type of prosthesis on the late outcome of patients with combined mitral-aortic valve replacement was analyzed by comparing, at a 14-year follow-up, patients receiving two biological prostheses (group 1; n = 135), two mechanical prostheses (group 2; n = 221), or a mechanical prosthesis in the aortic position and a bioprosthesis in the mitral position (group 3; n = 97). No difference was found among the three groups in terms of actuarial survival and incidence of and freedom from valve-related deaths, thromboemboli, and hemorrhages. Patients with biological prostheses had a significantly greater incidence of structural valve deterioration, reoperations, and overall complications when compared with patients with only mechanical prostheses. The results of an extended follow-up of patients with combined mitralaortic valve replacement indicate that mechanical prostheses perform better in the long-term owing to their superior durability when compared with biological valves. The use of bioprostheses should be confined to old patients with limited life expectancy because of their cardiac disease, provided that anticoagulants are not used. Combination of mechanical and biological prostheses in the same patient should be avoided because the advantages of each type of prosthesis are lost.

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