Outcomes of tissue versus mechanical aortic valve replacement in patients 50 to 70 years of age

Abstract

Background Societal guidelines suggest that aortic valve replacement (AVR) in patients age 50 to 70 years can be performed with either bioprosthetic or mechanical valves. This study reviewed outcomes between these valve types among patients aged 50 to 70 years undergoing AVR. Methods We examined adult patients 50 to 70 years undergoing isolated AVR with a mechanical or bioprosthetic valve at a single institution between 2010 and 2018. Kaplan‐Meier analysis was used to evaluate longitudinal survival and multivariable Cox regression analysis was used for risk adjustment. A propensity‐matched analysis was performed as well. Results A total of 723 patients underwent isolated AVR with 467 (64.6%) receiving a bioprosthetic valve. At baseline, patients undergoing bioprosthetic AVR were older (median 65 vs 60 years; P < .001). One‐year survival was comparable, however, survival at 5 years was significantly higher among patients undergoing mechanical AVR (95.5% vs 82.6%; P = .010). Among the 196 matched pairs, bioprosthetic AVR was associated with an increased adjusted hazard for death (hazards ratio, 3.29; P < .001). Additionally, 5‐year freedom from stroke and bleeding were similar following matching, though mechanical AVR was associated with a greater freedom from repeat valve intervention (97.5% vs 92.9%; P = .020). Conclusion In patients age 50 to 70, mechanical AVR is associated with improved long‐term survival and freedom from repeat aortic valve intervention. Further large cohort studies should be performed to explore the potential benefits of mechanical valve replacement in this age range.

Real-World Comparison of Transcatheter Versus Surgical Aortic Valve Replacement in the Era of Current-Generation Devices

“…In this study, the surgery group showed numerically higher mortality than that observed in previous studies [ 25 , 26 ]. We assumed that PSM might eliminate the low-risk patients and assign more elderly patients with poor comorbidities to the SAVR cohort than crude analyses.…”

Mechanical versus Bioprosthetic Aortic Valve Replacement in Middle-Aged Adults: A Systematic Review and Meta-Analysis

“…We also focus on those two aspects in our study. Thirdly, these two analyses were published in 2016 and 2018; several retrospective studies have been published since then, most of which were multi-center and even nationwide, which may provide more accurate results [ 3 , 16 , 23 , 28 , 29 , 32 , 33 ]. Therefore, we conducted this meta-analysis to further compare the clinical outcomes of mechanical and bioprosthetic prostheses in middle-aged patients receiving AVR surgery to give clinicians an update on this topic.…”

Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database

“… 29 Another group demonstrated in the 50–70 years old cohort that survival at 5 years was higher in patients who had undergone SAVR with mechanical valve versus bioprosthesis and also demonstrated similar freedom from major bleeding events. 31 …”

“…29 Another group demonstrated in the 50-70 years old cohort that survival at 5 years was higher in patients who had undergone SAVR with mechanical valve versus bioprosthesis and also demonstrated similar freedom from major bleeding events. 31 Bicuspid aortic valve and aneurysm of the aorta A significant number of patients requiring SAVR have bicuspid aortic valve, which has an incidence of 1%-2% in the general population and may present with aortic valve stenosis, regurgitation and ascending aortic aneurysm. The type of native aortic valve is not recorded in the database of our study.…”