{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:16Z","timestamp":1787028616671,"version":"build-2736575974"},"reference-count":21,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T00:00:00Z","timestamp":1665014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Heart Laboratory","award":["RRF-2.3.1\u201321\u20132022\u201300003"],"award-info":[{"award-number":["RRF-2.3.1\u201321\u20132022\u201300003"]}]},{"name":"National Heart Laboratory","award":["\u00daNKP-21\u20133-I-SE-75"],"award-info":[{"award-number":["\u00daNKP-21\u20133-I-SE-75"]}]},{"name":"New National Excellence Program of the Ministry for Innovation and Technology","award":["RRF-2.3.1\u201321\u20132022\u201300003"],"award-info":[{"award-number":["RRF-2.3.1\u201321\u20132022\u201300003"]}]},{"name":"New National Excellence Program of the Ministry for Innovation and Technology","award":["\u00daNKP-21\u20133-I-SE-75"],"award-info":[{"award-number":["\u00daNKP-21\u20133-I-SE-75"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Objectives: Balancing anticoagulation and reoperation risks determines prostheses choice (mechanical\/biological) for mitral valve replacement. We aimed to re-evaluate the outcomes after biological versus mechanical mitral valve replacement. Methods: We compared long-term benefits and risks of mechanical and biological prostheses in 2056 patients (52% men, 48% women; 65.4 \u00b1 12.1 years) who underwent mitral valve replacements between 1993\u20132017, in a retrospective single-centre study. Data sources included prospective institutional database, social registry, general practitioner data and follow-up questionnaire. Patients were stratified by age: &lt; = 39 y (n = 82), 40\u201349 y (n = 164), 50\u201359 y (n = 335), 60\u201369 y (n = 593), 70\u201379 y (n = 743) and &gt; = 80 y (n = 139). Long-term outcomes (mortality, reoperations, bleeding) were analysed. Results: Altogether, 1308 mechanical (53% men, 47% women; 61.5 \u00b1 11.7 years) and 748 biological (50% men, 50% women; 72.3 \u00b1 9.6 years) valves were implanted. The reason for valve replacement was stenosis in 162, insufficiency in 823 and combined in 323 cases for mechanical, while it was 46, 567 and 135 for biological valves, respectively. Overall cumulative survival was higher with mechanical prosthesis (mean: 139 \u00b1 4 vs. 102 \u00b1 5 months, 10 y: 55% vs. 33%, p &lt; 0.0001). Subgroup analysis revealed higher survival among patients receiving mechanical prosthesis up to 60 years (&lt; = 39 y p = 0.047, 40\u201349 y p &lt; 0.0001, 50\u201359 y p = 0.001). In patients 60\u201369 years, overall survival did not differ; however, in survivors beyond 8 years, mechanical prosthesis showed improved survival (p = 0.014). While between 70\u201379 years survival was nearly identical, for above 80 years, patients had a higher survival with biological prosthesis (p = 0.014). Conclusion: The present data demonstrated a higher survival of mechanical prosthesis in a wide range of patients after mitral valve replacement.<\/jats:p>","DOI":"10.3390\/jcdd9100339","type":"journal-article","created":{"date-parts":[[2022,10,8]],"date-time":"2022-10-08T23:39:31Z","timestamp":1665272371000},"page":"339","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Long-Term Outcomes Stratified by Age in Patients with a Mechanical versus Biological Mitral Valve Replacement"],"prefix":"10.3390","volume":"9","author":[{"given":"G\u00e1bor","family":"Veres","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, 06120 Halle (Saale), Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K\u00e1lm\u00e1n","family":"Benke","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, 06120 Halle (Saale), Germany"},{"name":"Heart and Vascular Center, Semmelweis University, V\u00e1rosmajor u. 68, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Stengl","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, V\u00e1rosmajor u. 68, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University of Heidelberg, INF 326, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ereva","family":"Marina","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University of Heidelberg, INF 326, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00e1bor","family":"Szab\u00f3","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, 06120 Halle (Saale), Germany"},{"name":"Department of Cardiac Surgery, University of Heidelberg, INF 326, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Karck","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University of Heidelberg, INF 326, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/S0140-6736(06)69208-8","article-title":"Burden of valvular heart diseases: A population-based study","volume":"368","author":"Nkomo","year":"2006","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/S0195-668X(03)00201-X","article-title":"A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease","volume":"24","author":"Iung","year":"2003","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1055\/s-0040-1710569","article-title":"German Heart Surgery Report 2019: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery","volume":"68","author":"Beckmann","year":"2020","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_4","first-page":"1","article-title":"Mitral Valve Replacement\u2014Current and Future Perspectives","volume":"9","author":"Casselman","year":"2017","journal-title":"Open J. Cardiovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1093\/ejcts\/ezab389","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"60","author":"Vahanian","year":"2021","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1001\/jama.2015.3164","article-title":"Survival and Outcomes Following Bioprosthetic vs. Mechanical Mitral Valve Replacement in Patients Aged 50 to 69 Years","volume":"313","author":"Chikwe","year":"2015","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13019-019-0943-6","article-title":"Long-term outcome after mitral valve replacement using biological versus mechanical valves","volume":"14","author":"Cetinkaya","year":"2019","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1056\/NEJMoa1613792","article-title":"Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement","volume":"377","author":"Goldstone","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.jtcvs.2017.08.018","article-title":"Survival and long-term outcomes after mitral valve replacement in patients aged 18 to 50 years","volume":"155","author":"Schnittman","year":"2018","journal-title":"J. Thorac. Cardiovasc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1016\/j.athoracsur.2013.05.014","article-title":"Mechanical Prosthesis Is Reasonable for Mitral Valve Replacement in Patients Approximately 65 Years of Age","volume":"96","author":"Nishida","year":"2013","journal-title":"Ann. Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1016\/j.jtcvs.2004.09.042","article-title":"Performance of bioprostheses and mechanical prostheses assessed by composites of valve-related complications to 15 years after mitral valve replacement","volume":"129","author":"Jamieson","year":"2005","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.ejcts.2006.06.013","article-title":"Mechanical versus bioprosthetic valve replacement in middle-aged patients","volume":"30","author":"Kulik","year":"2006","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"I-294","DOI":"10.1161\/CIRCULATIONAHA.106.681429","article-title":"Very long-term survival implications of heart valve replacement with tissue versus mechanical prostheses in adults","volume":"116","author":"Ruel","year":"2007","journal-title":"Circulation"},{"key":"ref_14","first-page":"e72","article-title":"2020 ACC\/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1016\/j.jtcvs.2008.08.071","article-title":"Surgery for aortic and mitral valve disease in the United States: A trend of change in surgical practice between 1998 and 2005","volume":"137","author":"Barnett","year":"2009","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1053\/j.semtcvs.2011.04.008","article-title":"Durability of tissue valves","volume":"23","author":"Chikwe","year":"2011","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1016\/S0735-1097(00)00834-2","article-title":"Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: Final report of the Veterans Affairs randomized trial","volume":"36","author":"Hammermeister","year":"2000","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1067\/mtc.2001.115238","article-title":"Twenty-year comparison of tissue and mechanical valve replacement","volume":"122","author":"Khan","year":"2001","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e018506","DOI":"10.1161\/JAHA.120.018506","article-title":"Degeneration of bioprosthetic heart valves: Update 2020","volume":"9","author":"Kostyunin","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_20","first-page":"1","article-title":"Anticoagulation after mechanical aortic valve implantation: Is it time to act after PROACT?","volume":"6","author":"Durko","year":"2018","journal-title":"Ann. Transl. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"663","DOI":"10.21037\/cdt.2018.07.02","article-title":"Antiplatelet therapy for peripheral artery disease","volume":"8","author":"Melfi","year":"2018","journal-title":"Cardiovasc. Diagn. 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