Mitral Valve Replacement with Bioprosthesis in Age Group Fifty to Sixty-Five Years

Between 1982 and 1990, 151 patients aged 50 to 65 years of age underwent isolated mitral valve replacement with a bioprosthesis. Overall hospital mortality was 10.6% (16/151). The total cumulative follow-up period was 527.6 patient-years with a mean of 4.34 ± 2.53 years and a range of 2 months to 10.9 years. During the follow-up period, 27 patients (5.11% per patient-year) developed bioprosthesis dysfunction of whom 26 were reoperated and one was treated medically, 4 patients had thromboembolic complications (0.75% per patient-year), one patient (0.18% per patient-year) had anticoagulant-related bleeding, and two patients (0.37% per patient-year) had a paravalvular leak (one was reoperated). Total valve-related complications were 6.44% per patient-year. Late mortality was 2.65% per patient-year (14/151). Ten-year actuarial survival was 78.5%. Freedom from bioprosthesis dysfunction was 56.6%, from thromboembolic complications 95.8%, and from all complications 49.6%. Our findings of a high rate of bioprosthesis dysfunction as well as a low rate of thromboembolic complications after mitral valve replacement with a bioprosthesis in older patients suggests that the use of bioprostheses should be limited.