Study Cohort
This study included patients with severe MV disease that underwent MVR at the University of Alberta Hospital between January 1, 2004, and December 31, 2018 (Figure 1). Exclusion criteria included repair of the MV or if data was incomplete (n=1673), if they were in a critical preoperative state (n=24) (need for intra-aortic balloon pump, acute renal failure requiring dialysis, respiratory failure requiring ventilation), or if there was a preoperative diagnosis of endocarditis (n=96). A total of 1072 patients were included consisting of 476 males and 596 females (Figure 1). After propensity matching, 314 males and 314 females were included. Patients were followed for a maximum of 16 years with a median follow-up of 8.4 years.