Comparison of Propensity Scores for Surgical Treatment of Bioprosthetic Mitral Valve Dysfunction Using Traditional and “Valve-in-Valve” Methods

Abstract

HighlightsThe article describes the first conducted pseudorandomized comparative study of mitral valve replacement using either traditional or “valve-in-valve” techniques. AbstractAim. To compare short-term (perioperative) and medium-term (6 months) outcomes of surgical treatment of bioprosthetic mitral valve dysfunction using traditional and “valve-in-valve” methods.Methods. The study included 18 patients undergoing “valve-in-valve” replacement and 18 patients undergoing traditional mitral valve replacement (open mitral valve replacement) chosen according to the following criteria: heart disease type, predominant type of defect, age, gender, severity of the disease and the presence of concomitant pathology and using 1:1 matching on the propensity score.Results. No perioperative mortality was noted in both groups. The cardiopulmonary bypass and cross-clamping of the aorta time was significantly lower in the “valve-in-valve” group. Comparison of echocardiographic parameters revealed a decrease in the mean pulmonary arterial pressure gradient, and a decrease in the size of the heart chambers in both groups. The peak and mean transvalvular gradient were lower in the “traditional” group. There were no cases of patient-prosthesis mismatch. In the mid-term period, patients in both groups presented with a lower functional class of heart failure.Conclusion. Bioprosthetic mitral valve replacement using the “valve-in-valve” technique provides comparable clinical and hemodynamic results compared to the “traditional” technique in short-term and mid-term periods, and significantly reduces cardiopulmonary bypass and aortic cross clamping time.