Outcome of heart valve prosthesis in Bangladesh: A retrospective study

Abstract

Background: Prosthetic heart valve for middle aged patients requiring valve replacement remains controversialBecause of the co-morbidities and limited life expectancy, bioprosthesis is the likely choice for older aged patients.

Objective: The aim of the study was to quantify long term survival rate and major morbidity in patients undergoing heart valve replacement and to optimise selection criteria of biologic versus mechanical valve prostheses.

Methods: This retrospective cohort study evaluated among 565 patients of 45 to 65 years of age  undergoing isolated, primary heart valve replacement in either aortic or mitral position using mechanical or bioprosthetic valve.

Results:Long time survival benefit was similar between aortic valve replacement (AVR) versus mitral valve replacement (MVR) patients regarding replacement with either mechanical and bioprosthetic valve. Postoperative incidence of morbidities like valve related complications, endocarditis, and bleeding were statistically not significant in this study. There was no significant difference in terms mortality after both AVR and MVR regarding use of bioprosthesis versus mechanical valve. Although, most common causes of mortality were prosthesis related and haemorrhage that was observed in both study group. Follow up at 10 years observed mean survival rate were 86.6%, 90.3% in mechanical AVR and MVR respectively, whereas patients with bioprosthesis demonstrate survival rate of 82.3% after AVR and 76.9% following MVR.

Conclusion: With a life expectancy of at least 15 years, mechanical prostheses should be considered in patients below 50 years in Bangladesh. However, patients more than 50 years of age or with multiple comorbidities like coronary artery disease, renal disease, lung disease, coronary disease, or a life expectancy less than 15 years, bio prostheses may be good options for better outcome.