OBJECTIVES The goal of this multicentre retrospective study was to compare long-term clinical and haemodynamic outcomes of the Carpentier-Edwards Magna Ease (CEME) bioprosthesis by patient age. METHODS We included consecutive patients who underwent isolated and combined surgical aortic valve replacement (AVR) with CEME valve between January 2008 and March 2020 at 4 cardiac surgery centres in Italy. Survival distribution was evaluated at follow-up according to age and surgery type (combined or isolated AVR), together with freedom from structural valve deterioration (SVD), reoperation and combined events, i.e. SVD, reoperation, endocarditis and thromboembolic events. RESULTS A total of 1027 isolated and 1121 combined AVR were included; 776 patients were younger than 65 years whereas 1372 were 65 years or older. The 30-day Valve-Academic-Research-Consortium mortality was 2% (<65 years) and 6% (≥ 65 years) (P < 0.001), whereas it was 3% for isolated AVR and 7% for combined AVR (P < 0.001). The 12-year survival was 81% for those younger than 65 years vs 45% for those equal to or older than 65 years (P < 0.001), whereas they were 61% vs 49% for isolated and combined AVR (P = 0.10). The 12-year freedom from combined events, excluding death, was 79% for those younger than 65 years vs 87% for those equal to or older than (P = 0.51), whereas they were 83% for isolated and 86% for combined AVR (P = 0.10). The 12-year freedom from SVD was 93% and 93% in patients younger than 65 and those equal to or older than 65 years (P = 0.63), and the results were comparable even in cases with isolated and combined AVR (92% vs 94%, P = 0.21). A multivariable Cox analysis including gender, presence of patient–prosthesis mismatch, isolated AVR and age showed that only the age was an independent risk factor for the incidence of SVD (P = 0.029). CONCLUSIONS Outcomes from this large multicentre analysis demonstrated that a CEME bioprosthesis provides good clinical results and long-term durability even in patients younger than 65 years. Furthermore, the hazard for SVD has been shown to be lower for older age. Clinical trial registration number 105n/AO/21.

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OBJECTIVES Clinical outcomes of two generations of pericardial bioprostheses in concomitant aortic valve and coronary artery bypass graft surgery were analyzed. METHODS Patients were recruited from two European centers and divided into 2 groups based on the type of aortic bioprosthesis used: Edwards Intuity EliteTM rapid deployment bioprostheses or standard Edwards Magna Ease (Edwards Lifesciences, Corporation, Irvine, California, US). A propensity score weighting approach was used for data analysis. RESULTS 285 patients were included: 144 (50.5%) in the Rapid Deployment group and 141 (49.5%) in the Magna Ease group. Thirty-day mortality was 2.8% (Rapid Deployment) and 5% (Magna Ease) (P = 0.089). Significantly shorter times of aortic cross-clamp and cardiopulmonary bypass were observed in the Rapid Deployment cohort [94 vs 120 min; (P < 0.001); 128 vs 160 min (P < 0.001)]. The Rapid Deployment group was associated with a lower median transvalvular gradient at discharge and follow-up (both P < 0.001). However, 5-year survival was not different, being 93% in Rapid Deployment patients and 91% in the Magna Ease group [HR 0.89 (CI 95%:0.38–2.09), P = 0.784]. The 5-year cumulative incidence of combined events (including percutaneous coronary interventions, endocarditis, thromboembolic events, rehospitalizations, and bleeding) favored the Magna Ease group [16.1% (Rapid Deployment) vs 7.3% (Magna Ease), [HR 2.38 (CI 95%:1.03–5.52), P = 0.043]. However, this turned similar when the Cox model analysis was adjusted for revascularization variables (P = 0.067). CONCLUSIONS Rapid deployment and Magna Ease pericardial bioprostheses used in concomitant aortic valve replacement and coronary artery revascularization provide equivalent clinical and haemodynamic 5-year outcomes, despite constant lower transvalvular gradients and shorter surgical operating times observed with rapid deployment technology.