Should mitral valve replacement age guidelines be lowered due to better bioprosthetic mitral valve durability?

Objective Guideline recommendations for mechanical or bioprosthetic (BP) valve for MVR by age remains controversial. We sought to determine bovine pericardial valve durability by age, and risk of reintervention. Methods This retrospective study between 2 large university-based cardiac surgery programs examined patients who underwent BP MVR from 2004 to 2020. Follow-up was obtained through June 2022. Durability outcomes involving structural valve deterioration (SVD) were compared by age decile. Results Of 1544 available patients, mean age was 66±13 years and 652 (42%) were < 65 years old. Indications for MVR were: MR>2+ 53% [n=813]; mitral stenosis 44% [n=650]; endocarditis 18% [n=277] and reoperation in 39% [n=602]. Concomitant procedures were AVR 28% [n=426]; Tricuspid valve 36% [n=550]; CAB 19% [n=290]. Thirty-day mortality was 5.4%. In follow-up (clinical: median [IQR] 75 [25-129] months) reoperation for endocarditis, and new stroke were low (0.30 and 1.06 per 100 patient/years, respectively). The cumulative incidence of MV reintervention for SVD among all patients was 6.2% at 10 years 9.0% at 12 years with no statistical difference in SVD among patients between the ages of 40 and 70 years (p=0.1). Among 90 patients with MV reintervention, 30-day mortality after reintervention was 4.7% (n=2) for 43 MViV and 6.4% (n=3) among 47 reoperation patients. Conclusions Bovine pericardial MVR is a durable option for younger patients. The opportunity to avoid anticoagulation and the associated risks with mechanical MVR may be of benefit to patients. These insights may provide data needed to revise the current guidelines.