Commentary: Different problem, different place…same conversation

Central MessageThe relationship of patient age and long-term outcomes following bioprosthetic valve versus mechanical mitral replacement is similar in patients with rheumatic heart disease those degenerative disease.See Article page 1050. The disease. See choice between or severe remains controversial.1Chikwe J. Chiang Y.P. Egorova N.N. Itagaki S. Adams D.H. Survival vs aged 50 to 69 years.JAMA. 2015; 313: 1435-1442Crossref PubMed Scopus (90) Google Scholar maximum at which recommended has been cited as 65 70 years.2Goldstone A.B. Chiu P. Baiocchi M. Lingala B. Patrick W.L. Fischbein M.P. et al.Mechanical biologic prostheses for aortic-valve mitral-valve replacement.N Engl J Med. 2017; 377: 1847-1857Crossref (358) option future valve-in-valve transcatheter driven a recent shift toward use; however, there more experience this approach the aortic position.3Tuzcu E.M. Kapadia S.R. Vemulapalli Carroll J.D. Holmes Jr., D.R. Mack M.J. al.Transcatheter failed surgically implanted bioprostheses: STS/ACC Registry.J Am Coll Cardiol. 2018; 72: 370-382Crossref (123) Scholar,4Whisenant Eleid M.F. Kodali S.K. McCabe J.M. Krishnaswamy A. al.One-year using SAPIEN 3 valve.JAMA 2020; 5: 1245-1252Crossref (86) ideal unclear. Rheumatic etiologies (RHD) continue represent most common cause developing world. Although affects all ages, literature disproportionately directed younger patients. In current issue Journal, Chen colleagues5Chen C.-Y. Chan Y.-H. Wu V.C.-C. Liu K.-S. Cheng Y.-T. Chu P.-H. al.Bioprosthetic replacements disease.J Thorac Cardiovasc Surg. 2023; 165: 1050-1060.e8Abstract Full Text PDF (5) leverage Taiwan National Health Insurance Research Database compare after replacement. propensity score matched analysis 3653 RHD >20 years, multivariable model was developed late mortality other endpoints interest. Consistent studies disease, reintervention rate higher group. There non–statistically significant trend number thromboembolic events valves. When added an interaction term, benefit valves present until years. authors should be commended well-designed robust national database. study generates important data surgeons choosing appropriate prosthesis RHD, conversation remarkably that patient-specific decision, accounting age, need anticoagulation, comorbidities, anatomy, among factors, etiology playing less role. Whether seems consistent inflection point before durability can expected translate into overall survival patient. Bioprosthetic diseaseThe Journal Thoracic Cardiovascular SurgeryVol. 165Issue 3PreviewRheumatic critical problem countries. Few have compared who received (MV) Full-Text