Long-Term Outcomes of Bioprosthetic Valves in Mitral Position: A Systematic Review of Studies Published in the Last 20 Years

The use of bioprostheses for mitral valve replacement is well established and steadily increasing worldwide. However, long-term durability is not well described. Accurate mitral valve bioprosthetic durability reports are necessary to set a standard against which transcatheter mitral valve replacement can be compared. This systematic review aimed to assess the outcomes of bioprosthetic surgical mitral valve replacement based on data from studies published over the last twenty years. Only studies with follow-up beyond a minimum of five years were included in the analysis.

A total of twenty-one studies, including 15.833 patients, were identified and analyzed. Among all implanted bioprostheses, 64 percent were porcine and 36 percent were bovine pericardial. Freedom from structural valve deterioration at ten years ranged from 58.9 percent to 100 percent and at fifteen years from 58.3 percent to 93 percent. Freedom from reoperation ranged from 65 percent to 98.7 percent at ten years and 78.5 percent to 91 percent at fifteen years. There is, however, a lack of information regarding the preoperative baseline mitral valve pathology and insufficient echocardiographic follow-up. Hence, despite the reported results, the authors concluded that there is a considerable variability in reporting long-term outcomes following bioprosthetic mitral valve replacement and therefore an unbiased and generalizable understanding of the long-term outcomes following bioprosthetic mitral valve replacement is difficult across the spectrum of mitral valve pathologies requiring replacement surgery.