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96 to 0.99, p0.001), chronic kidney disease (HR 3.27, 95% CI 1.74 to 6.12, p0.001), elevated mean diastolic pressure gradient 5.5 mm Hg across the bioprosthetic MV early after operation (HR 2.02, 95% CI 1.08 to 3.78, p=0.028) and average haemoglobin level after surgery (HR 0.80, 95% CI 0.67 to 0.96, p=0.015). Patients with bioprosthetic MVD showed significantly poorer clinical outcomes than those without bioprosthetic MVD (log-rank p0.001). Young age at operation, chronic kidney disease, elevated pressure gradient across the bioprosthetic MV