P121. Comparisons of Long-term Outcomes after Mechanical Mitral Replacement: Asian Versus Western Populations

McCormick Place Lakeside Center  

Objective: Although the recommended target INR for anticoagulation therapy after mitral valve replacement (MVR) does not vary by race, current guidelines are largely based on studies conducted in Western population. However, studies have suggested that the optimal level of anticoagulation may differ between Asian and Western populations. This study aimed to compare long-term outcomes after mechanical MVR between Asian and Western populations.
Methods: From 2000 to 2020, 980 consecutive patients undergoing mechanical MVR were enrolled at two tertiary centers located in Asia and West, respectively. Propensity scores were calculated using 22 preoperative and operative variables, and 1:1 propensity score matching was performed to compare outcome between Asian group (n=508) and Western group (n=472). Bleeding events were defined according to the VARC-3 criteria, and type 2 or higher was classified as major bleeding. The composite outcome of thromboembolic and bleeding events included major bleeding (type 2 or higher) and thromboembolic events.
Results: Before matching, significant differences were observed in baseline characteristics such as age, hypertension and overweight and atrial fibrillation between Asian and Western groups. Overall, the Aian population demonstrated significantly better long-term survival, and lower incidences of thromboembolic events, any bleeding and the composite outcome of bleeding and thromboembolic events. After matching, 141 well-balanced pairs were obtained. In the matched cohort, overall survival remained significantly better in the Asian group (P < 0.001). While there was no significant difference in any bleeding events between the groups (P = 0.231), major bleeding occurred significantly more frequently in the Western group (P = 0.028). Thromboembolic events and the composite outcome of major bleeding and thromboembolic events were also significantly more frequent in the Western group (P = 0.002 and P = 0.013, respectively).

Conclusions: After mechanical MVR, Asian patients demonstrated superior long-term survival and a lower incidence of anticoagulation-related complications, including bleeding and thromboembolic events, compared with Western patients. These findings suggest that population-based differences should be considered when determining prosthetic valve type, and highlight the need for further research to define optimal anticoagulation targets tailored to Asian populations.

Authors
Jae Woong Choi (1), Yoonjin Kang (1), Suk Ho Sohn (1), Ho Young Hwang (1), Kyung Hwan Kim (1), Jeffrey Gaca (2), Brittany Zwischenberger (2), Carmelo Milano (2), Keith Carr (2), Donald Glower (2)
Institutions
(1) Seoul National University Hospital, Seoul, South Korea, (2) Duke University Medical Center, Durham, NC

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Mitral and Tricuspid Valve