COMPARATIVE ANALYSIS OF MITRAL VALVE REPAIR AND REPLACEMENT USING BIOLOGICAL PROSTHESIS IN ELDERLY PATIENTS (PSM method)

Highlights

As evidenced in literature, mitral valve (MV) repair for mitral regurgitation has many advantages, however, elderly patients have an extremely low risk of valve tissue degeneration, thus making the use of this type of surgery in this patient population controversial.

Aim. To analyze the role of bioprostheses in the older age group of patients undergoing mitral valve replacement and compare the results to mitral valve repair outcomes.

Methods. The study included elderly patients (over 65 years old) with mitral regurgitation who underwent mitral valve repair and annuloplasty using the biological annuloplasty ring NeoRing (Neokor CJSC, Kemerovo) or the annuloplasty ring RIGID (NPP MedInj CJSC, Penza) (n = 19) at the Research Institute for Complex Issues of Cardiovascular Diseases (Kemerovo, Russian Federation). To select pairs from a larger group of UniLine recipients for a sample of patients with annuloplasty rings, pseudorandomization (propensity score matching) was performed using the STATA 13.0 software package (StataCorp, USA) by identifying nearest neighbors.

Results. Patients of both groups did not experience thromboembolic and hemorrhagic complications during in-hospital period or 1-year follow-up period. At the same time, in the MV repair group, there was one case of new-onset atrial fibrillation, as well as two in-hospital cardiac deaths (due to myocardial infarction, and during surgery for recurrence of mitral regurgitation grade ≥ 2). One nonvalvular death (covid pneumonia) was recorded in the groups of UniLine recipients during the 1-year follow-up period.

Conclusions. Taking into account that in the vast majority of Russian clinics MV replacements prevail over MV repairs, elderly patients undergoing mostly MV replacement and receiving bioprostheses can be justified because the outcome is comparable to results of MV repair, primarily due to the lack of need for long-term anticoagulant therapy and comparable stable hemodynamic results in both groups.

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