Long-term outcomes after mechanical aortic valve replacement with aortic root enlargement in adolescents

Abstract

BACKGROUND: Deciding which prosthetic aortic valve to choose is difficult in adolescents who

Hospital readmission rates are similar between patients with mechanical versus bioprosthetic aortic valves

“…Both mAVR and bAVR have risks and benefits with bleeding events generally occurring more frequently with mAVR and SVD more prevalent for bAVR . However, the finding of increased bleeding events for mAVR is not consistent with recent studies …”

“…Both patient‐ and prosthesis‐related factors should be taken into account prior to the recommendation of a valve choice by the surgeon. mAVR in the aortic position remain an excellent treatment option in adolescents and young adults with freedom from valve‐related events as high as 88% at 4 years . Both mAVR and bAVR have risks and benefits with bleeding events generally occurring more frequently with mAVR and SVD more prevalent for bAVR .…”

“…The choice of prosthesis did not have a risk-adjusted impact on operative mortality at 30 days, 1 year, or 5 years ( mAVR in the aortic position remain an excellent treatment option in adolescents and young adults with freedom from valve-related events as high as 88% at 4 years. 17 Both mAVR and bAVR have risks and benefits with bleeding events generally occurring more frequently with mAVR and SVD more prevalent for bAVR. [10][11][12][13][14] However, the finding of increased bleeding events for mAVR is not consistent with recent studies.…”

“…[10][11][12][13][14] However, the finding of increased bleeding events for mAVR is not consistent with recent studies. [15][16][17][18][19][20] Stassano et al, 15 16,21,23 In 2013, the Society of Thoracic Surgeons Adult Cardiac Surgery National Database reported that there was a 20% increase in the proportion of patients selecting bAVR over mAVR among all age groups and this trend has continued. 24 The use of bAVR has continued to increase with the thought that when SVD occurs in bAVR, they can be treated with a TAVR V-I-V approach.…”

Is there still a role for mechanical aortic valve prostheses in the TAVR era?

“…With the introduction of the On‐X mAVR, INR levels as low as 1.8 have been shown to be safe and effective, thus further reducing the risk of bleeding complications . A mAVR has been a reliable prosthesis for adolescents and young adults, with freedom from valve‐related events as low as 88% at 4 years of follow‐up . Recent studies in adults have also shown no difference in bleeding complications between mAVR and bAVR …”