Biological versus mechanical aortic valve replacement in non-elderly patients: a single-centre analysis of clinical outcomes and quality of life

Stocco, Fabio; Fabozzo, Assunta; Bagozzi, Lorenzo; Cavalli, Chiara; Tarzia, Vincenzo; D’Onofrio, Augusto; Lorenzoni, Giulia; Chiminazzo, Valentina; Gregori, Darío; Gerosa, Gino

doi:10.1093/icvts/ivaa306

Cited by 10 publications

(9 citation statements)

References 19 publications

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“…Most studies showed the risk of re-intervention is higher in bioprostheses although the risk of major bleeding is lower. However, the long-term survival benefits remain controversial with some studies demonstrating a survival benefit with mechanical valves ( 26 – 28 ) while some did not ( 29 – 32 ). Although the survival benefits could be due to primary valve failure, which could be less of an issue due to the advancement of TAVR, particularly in patients who are at high risk for a redo of SAVR.…”

Section: Discussionmentioning

confidence: 99%

Trend and early outcomes in isolated surgical aortic valve replacement in the United Kingdom

Chan

Dimagli

Fudulu

et al. 2023

Front. Cardiovasc. Med.

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ObjectiveSurgical aortic valve replacement (SAVR) is traditionally the gold-standard treatment in patients with aortic valve disease. The advancement of transcatheter aortic valve replacement (TAVR) provides an alternative treatment to patients with high surgical risks and those who had previous cardiac surgery. We aim to evaluate the trend, early clinical outcomes, and the choice of prosthesis use in isolated SAVR in the United Kingdom.MethodsAll patients (n = 79,173) who underwent elective or urgent isolated surgical aortic valve replacement (SAVR) from 1996 to 2018 were extracted from the National Adult Cardiac Surgery Audit database. Patients who underwent additional procedures and emergency or salvage SAVR were excluded from the study. Trend and clinical outcomes were investigated in the whole cohort. Patients who had previous cardiac surgery, high-risk groups (EuroSCORE II >4%), and predicted/observed mortality were evaluated. Furthermore, the use of biological prostheses in five different age groups, that are <50, 50–59, 60–69, 70–79, and >80, was investigated. Clinical outcomes between the use of mechanical and biological aortic valve prostheses in patients <65 years old were analyzed.ResultsThe number of isolated SAVR increased across the study period with an average of 4,661 cases performed annually after 2010. The in-hospital/30-day mortality rate decreased from 5.28% (1996) to 1.06% (2018), despite an increasing trend in EuroSCORE II. The number of isolated SAVR performed in octogenarians increased from 596 to 2007 (the first year when TAVR was introduced in the UK) to 872 in 2015 and then progressively decreased to 681 in 2018. Biological prosthesis usage increased across all age groups, particularly in the 60–69 group, from 24.59% (1996) to 81.87% (2018). There were no differences in short-term outcomes in patients <65 years old who received biological or mechanical prostheses.ConclusionSurgical aortic valve replacement remains an effective treatment for patients with isolated aortic valve disease with a low in-hospital/30-day mortality rate. The number of patients with high-risk and octogenarians who underwent isolated SAVR and those requiring redo surgery has reduced since 2016, likely due to the advancement in TAVR. The use of biological aortic prostheses has increased significantly in recent years in all age groups.

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Section: Discussionmentioning

confidence: 99%

Trend and early outcomes in isolated surgical aortic valve replacement in the United Kingdom

Chan

Dimagli

Fudulu

et al. 2023

Front. Cardiovasc. Med.

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“…Mechanical valves may offer longer durability but require lifelong anticoagulation with a potential risk of bleeding or pannus formation with leaflet restriction depending on the adequacy of anticoagulation. 6 In contrast, bioprosthetic valves have been associated with greater risk of structural valve deterioration (SVD), especially in younger patients, and with reduced overall survival in patients younger than 50 years. 7 , 8 The potential of valve-in-valve therapies may reduce the need for redo MVR, thereby impacting the likelihood of younger patients receiving a bioprosthetic valve.…”

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confidence: 99%

Mid-term outcomes of the COMMENCE trial investigating mitral valve replacement using a bioprosthesis with a novel tissue

Heimansohn¹,

Baker²,

Rodríguez³

et al. 2023

JTCVS Open

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“…The general study characteristics are presented in Table 1 and in Table S1 (Supplementary Materials) . In total, 16 studies from 11 countries were included, 12 of which reported results from PMS cohorts [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ], and a further 4 studies reported results from multivariate analysis [ 24 , 25 , 26 , 27 ]. Of those studies, only one was RCT study [ 26 ].…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, as shown in Table 4 , 111 studies reported that more frequent reoperation was required for patients with BVs. Finally, three studies showed no significant difference in terms of complications observed between the two groups [ 13 , 14 , 16 ]. The three studies which showed better survival outcomes for the MV group compared to BV group were for patients aged 50–70 years.…”

Section: Resultsmentioning

confidence: 99%

Surgical Aortic Valve Replacement in Patients Aged 50 to 70 Years: Mechanical or Bioprosthetic Valve? A Systematic Review

Sigala,

Kelesi,

Terentes-Printzios

et al. 2023

Healthcare

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Although transcatheter aortic valve implantation has emerged as a very attractive treatment option for severe aortic valve disease, surgical aortic valve replacement (SAVR) is still considered the standard-of-care, particularly in younger patients. However, selecting the appropriate type of valve prosthesis for this patient population can pose challenges. The aim of this systematic review was to investigate morbidity and mortality in patients aged 50–70 years who have undergone a first-time SAVR, and to define and compare the outcomes of mechanical valve (MV) and biological valve (BV) prosthesis. A systematic search was conducted to investigate the clinical outcomes of MVs and BVs in patients aged 50–70 years following the PRISMA guidelines. A total of 16,111 patients were included in the studies with an average follow-up of 10 years. A total of 16 studies were selected, 12 of which included propensity-score-matching (PMS) analysis and 4 of which obtained results via multivariate analysis. The vast majority (13 studies) showed no greater survival benefit in either MVs and BVs, while three studies showed an advantage of MVs over BVs. Regarding complications, bleeding was the most common adverse event in patients undergoing MV replacement, while for patients receiving BV prosthesis, it was structural valve deterioration and reoperation. Although the data suggest that the BV option could be a safe option in patients younger than 70 years, more studies with contemporary data are needed to draw firm conclusions on the risks and benefits of BV or MV in SAVR. Physicians should individualize the surgical plan based on patient characteristics.

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Biological versus mechanical aortic valve replacement in non-elderly patients: a single-centre analysis of clinical outcomes and quality of life

Cited by 10 publications

References 19 publications

Trend and early outcomes in isolated surgical aortic valve replacement in the United Kingdom

Trend and early outcomes in isolated surgical aortic valve replacement in the United Kingdom

Mid-term outcomes of the COMMENCE trial investigating mitral valve replacement using a bioprosthesis with a novel tissue

Surgical Aortic Valve Replacement in Patients Aged 50 to 70 Years: Mechanical or Bioprosthetic Valve? A Systematic Review

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