Background and aim: The ultimate goal of mitral valve surgery in young women is to extend life expectancy and improve quality of life. Mitral valve replacement (MVR) prosthesis in middle-aged women is a difficult choice between the lifelong anticoagulation by mechanical prosthesis versus the limited long-term durability of bioprosthesis. The current trend towards reducing women’s age for selecting bioprosthesis over mechanical prosthesis leads to a dilemma for younger women decision making.1,2 The aim of this study was to compare the safety and freedom from complications in pregnancy and survival rate after mitral valve bioprosthesis versus mechanical prosthesis in young women for whom mitral valve repair is not feasible or unsuitable. Methods: This single-center non randomized prospective propensity-matched comparative study included all female patients undergoing MVR at our center from January 2010 to February 2020. Results: In total, 355 patients underwent MVR at our center, of whom 174 received a bioprosthesis and 181 received a mechanical prosthesis. The use of anticoagulation among young women with mechanical prosthesis was associated with a remarkable risk of postoperative bleeding, abortion, and increased frequency of pregnancy-related complications (p < 0.0001). In contrast, there was a considerable survival benefit for those who received bioprosthesis (p = 0.0001). Conclusions: Our data confirm that the use of mitral bioprosthesis in young women who desire to become pregnant is safe, reduces complications, and increases survival.

Background: The ultimate goal of mitral valve surgery in younger women is to extend life expectancy and improve quality of life. Mitral valve replacement prosthesis in the middle-aged women is a difficult choice between the lifelong anticoagulation of a mechanical prosthesis versus a limited long-term durability of the bioprosthesis. The current trend towards reducing the women age for selection of the mitral bioprosthesis over a mechanical prosthesis lead to a dilemma for younger women decision making.1,2 The aim of this study is to compare the clinical out-comes after mitral valve bioprosthesis versus mechanical prosthesis in younger women population when mitral valves repair not feasible or unsuitable. Methods: A single-centre prospective non randomized registration of all women patients undergoing Mitral Valve Replacement at our center from January 2010 to February 2020 established. Results: Between January 2010 and February 2020, 355 female patients underwent mitral valve replacement at our center, 174 female patients of them had mitral valve replacement with mitral bioprosthesis (Mb) and 181 female patients of them had mitral valve replacement with mitral mechanical (Mm) prosthesis. Our study proved that the use of anticoagulation among the Mm young women associated with a remarkable risk of postoperative bleeding, abortion and increase frequency of the pregnancy related complication of the anticoagulation (p=< 0.0001), moreover, there is a considerable survival benefits for younger women patients received Mb(p= 0.0001). Conclusions: These data confirm that the impulse for the use of mitral bioprosthesis for young women population has been great with an astonishing survival benefits.