Commentary: Mitral bioprosthesis degeneration: Looking for a benchmark to tailor the correct procedure to the patient

Abstract

A full evaluation of patients with mitral bioprosthetic structural valve deterioration is of great importance to better select which patients would benefit from an either a surgical or VIV procedure.

Commentary: In the era of mitral valve-in-valve therapy, mechanical prosthesis in young patients does not deserve to be forgotten

“…When commenting on that article, we highlighted the concept that high-risk patients were evaluated by a multidisciplinary team to select those who could benefit from a mitral ViV approach. 3 In fact, this procedure (especially the transfemoral approach) has been reported to be safe in selected high-risk surgical patients. 4 Some recently published studies have reported the advantage of using the mechanical prosthesis compared with bioprosthesis in young subjects undergoing mitral valve replacement in terms of greater long-term survival and lower rate of reoperation for mechanical prosthesis.…”

“…This point is of paramount importance and should be strongly considered in the surgical plan. In fact, because the patients who underwent combined prosthetic valve replacement would became high-risk surgical patients compared with those patients who received an isolated prosthesis replacement, 3 considering that the incidence of embolic and bleeding events are similar between the 2 types of prosthesis 1,5,6 and in light of the most recent evidence regarding the promising results of mitral ViV procedures, 4,7 surgeons must not depart from the standard indication of offering a mechanical prosthesis for young patients and should consider the biological prosthesis only for those who refuse or who do not tolerate the anticoagulant therapy and in cases of isolated mitral valve replacement that would better tolerate the surgical risk of reoperation in the future.…”

Commentary: Mitral bioprosthesis versus mechanical prosthesis in severe chronic mitral regurgitation: Bioprosthesis wins the duel

“…of transcatheter therapy, valve-in-valve procedures to manage a degenerated mitral BP are increasing. 9 This could overcome the operative risk of conventional redo surgery 10,11 and therefore the prosthesis choice should be driven also on the potential valve-in-valve therapy criterion. Based on the results of the study by Bernard and colleagues, 8 we conclude that BP has to be the first choice in patients with severe CIMR when mitral repair is not advisable.…”