Appropriate Valve Selection in Valvular Heart Disease Surgery

Introduction: Heart valve disease continues to be a serious health problem across the world, and despite advances in surgical techniques for valve repair in recent decades, valve replacement is still frequently required. Unfortunately there is no ideal heart valve substitute, and the presently available mechanical and tissue heart valves both have their advantages and drawbacks. This study was designed to evaluate the quality of life and complications of these heart valves in two large groups of patients.Methods: From Jan. 2003 to January 2017, 1147 valve replacements were performed by a single surgical team. 619 were mechanical and 528 were bioprosthetic valves. Patients were followed for a mean of 8.5 years and follow-up was 65% complete. Choice of valve type was made by patients’ preference after counseling by the surgeon. Comparisons were made between the two groups for minor and major complications, as well as quality of life during the follow-up.Results: There were 634 males and 513 females. Males were twice as frequent in the mechanical valve group, whereas females were more frequent in the bioprosthetic valve group. Mean age was higher in the bioprosthetic group and hospital mortality was not significantly different in the two groups. However, major and minor bleeding episodes were three times more frequent in the mechanical valve group, as well as stroke. Furthermore, valve thrombosis and sudden cardiac death were also more frequent in the mechanical valve group, but did not reach statistical significance. Quality of life and general sense of well-being were statistically higher in the bioprosthetic valve group.Conclusion: Despite previous recommendations that bioprosthetic heart valves should be reserved for young females anticipating pregnancy and elderly patients (> 65 years old), recent studies as well as our experience show that bioprosthetic heart valves can be used more liberally, and have a significantly less adverse event rate and provide better quality of life for the patients.

Keywords:

heart valve surgery , mechanical heart valve , bioprosthetic heart valve , complications