Comparison of mechanical versus bioprosthetic valve replacement in mitral stenosis surgery

Mitral stenosis is a common valvular heart disease, and the choice of valve material during surgical treatment significantly impacts patient prognosis. Currently, data on mid-term outcomes following valve replacement in Chinese patients with mitral stenosis are limited. This study aimed to compare the clinical efficacy and mid-term prognosis between mechanical and bioprosthetic valves in mitral stenosis surgery. We retrospectively analyzed 200 patients who underwent mitral valve replacement at our cardiac surgery department between January 2015 and December 2020. Patients were divided into mechanical valve group (n = 80) and bioprosthetic valve group (n = 120) based on the valve material used. Preoperative clinical data, surgical parameters, and postoperative follow-up data were recorded, including postoperative complications, valve-related events, survival rates, and quality of life scores. The follow-up period ranged from 1 to 6 years. Comparing baseline characteristics between the two groups, the mean age in the bioprosthetic valve group was significantly higher than in the mechanical valve group (65.7 ± 8.3 years vs. 52.4 ± 9.6 years, P < 0.001). There was no significant difference in surgical mortality between the two groups (mechanical valve group 2.5% vs. bioprosthetic valve group 3.3%, P = 0.721). During the five-year follow-up period, the mechanical valve group had a higher incidence of bleeding complications than the bioprosthetic valve group (8.8% vs. 3.3%, P = 0.099), while the bioprosthetic valve group had a higher incidence of SVD than the mechanical valve group (7.5% vs. 1.3%, P = 0.049). The five-year survival rate was 92.5% in the mechanical valve group and 87.5% in the bioprosthetic valve group (P = 0.134). For patients with mitral stenosis, mechanical valves offer better durability but require lifelong anticoagulation therapy; bioprosthetic valves have fewer bleeding complications but carry the risk of valve deterioration. The choice of valve material should be individualized based on factors such as patient age, anticoagulation contraindications, and life expectancy. The results of this study provide important data on mid-term follow-up after valve replacement in a Chinese population.