Midterm Results of Mitral Valve Replacement for Heart Disease in Females in Child Bearing Period - Mechanical Versus Tissue Valves

Abstract Background: Current guidelines limit mitral valve replace-ment to irrepairable valve pathology that will result in poor durability outcomes, especially in patients unlikely to tolerate future reinterventions. There are two basic types of prosthetic heart valves used in current clinical practice: Mechanical and bioprosthetic valves. Young women planning pregnancy are considered high risk patients who require careful selection of the optimal prosthetic heart valve. Some authors advocate that mechanical heart valve prostheses, which require lifelong anticoagulant therapy (warfarin), are not appropriate because of the teratogenic potential of anticoagulants. However, the main issue with bioprosthetic heart valves is their finite lifespan and high risk of reoperation in the future. Aim of Study: To primary outcome: To compare midterm results of post-operative outcome between mechanical versus tissue valves in the terms of morbidity in females in the childbearing period. Hence guide future choice of prosthetic valves in females in childbearing period. Secondary outcome: To discuss the rate maternal complication for both types of valves during pregnancy. Patients and Methods: This study was conducted at the Cardiothoracic Surgery Department, Souad Kafafi University Hospital and Ain Shams University Hospitals. The study period starting between 2013 to 2018. Results: Our results showed that the pre-operative Left Ventricular End Diastolic Diameter (LVEDD), Left Ventricular End Systolic Diameter (LVESD) were significantly lower in the mechanical group and the Ejection Fraction (EF) was significantly lower in tissue group. The MVA was significantly lower and the pressure gradient was significantly higher in tissue group than mechanical group. Post-operatively, the LVEDD and LVESD remained significantly lower in mechan-ical group; however, the EF was comparable between both groups. Although, the post-operative pressure gradient was higher in tissue group, but it is not reflected on the durability of the valve at this age group regarding the midterm results of our study, and there were no statistically significant differ-ences between both groups in terms of MVA, incidence of new regurge, or paravalvular leak.
Conclusion: Tissue valves appear to be the preferred option for women in childbearing period with MVD with better mid-term results than mechanical valves. The present study demonstrated that women with mechanical valves had a high rate of pregnancy loss. The risk of cardiovascular complications is higher in mechanical valves, as the main risks are related to the need of anticoagulation therapy (hem-orrhagic and thromboembolic complication) additional risks related to ventricular and valvular dysfunction as well. Fur-thermore the rate of reoperation is much higher in mechanical valves. However the risk of complications is lower in tissue valves, it can be significant in the presence of bioprosthetic dysfunctions. So, large-scale, studies are still needed to confirm our findings.