Abstract: BACKGROUND: Mitral valve replacement with reserved subvalvular structure is an effective method for the treatment of valvular heart disease. The selection of prosthetic valve material plays an important role.
OBJECTIVE: To explore application effect of biological mitral valve replacement in elderly patients with valvular heart disease.
METHODS: Clinical data of 96 elderly patients with valvular heart disease who received mitral valve replacement from May 2017 to April 2019 in The 7th People’s Hospital of Zhengzhou were retrospectively analyzed. According to their conditions and wishes, the patients were divided into biological group (n=62) and mechanical group (n=34). The biological group received mitral valve replacement with reserved subvalvular structure biological valve. The mechanical group received mitral valve replacement with reserved subvalvular structure mechanical valve. Cardiac function, clinical efficacy, serum inflammatory factors, hemodynamics, and complications were compared between the two groups. This study was approved by the Ethics Committee of The 7th People’s Hospital of Zhengzhou (approval No. 20170315).  
RESULTS AND CONCLUSION: (1) In follow-up for 12 months, New York Heart Association class I was 71%, and clinical success rate was 77% in the biological group. New York Heart Association class I was 47%, and clinical success rate was 53% in the mechanical group. There was significant difference of New York Heart Association class I and clinical success rate between two groups (P < 0.05). There were no cases of reoperation or death caused by structural failure of artificial valve in the two groups. The thromboembolism, endocarditis and perivalvular leakage were lower in the biological group than those in the mechanical group (P < 0.05). (2) At 3 days after surgery, mass concentrations of serum interleukin 6 and tumor necrosis factor α were lower in the biological group than those in the mechanical group (P < 0.05). The mass concentration of serum interleukin 10 was higher in the biological group than that in the mechanical group (P < 0.05). (3) In follow-up for 12 months, early diastolic inflow velocity and maximun transvalvular pressure gradient were lower in the biological group than those in the mechanical group (P < 0.05). Effective orifice area was higher in the biological group than that in the mechanical group (P < 0.05). (4) The results show that biovalvular mitral valve replacement helps to improve cardiac function of elderly patients with heart valve disease, increases the clinical success rate, and reduces complications, which may be associated with antagonistic inflammatory stress response and improving hemodynamics. 

Key words: elderly, valvular heart disease, biological valve, mechanical valve, mitral valve replacement, inflammatory stress, hemodynamics