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

Abstract

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.

Balloon‐expandable transcatheter heart valves for treatment of aortic valve stenosis in patients with large aortic annuli: Evaluation of deployment balloon overfilling strategies

“…Theoretically, profound overfilling of the deployment balloon can lead to overstretching of the THV stent with consecutive decreased coaptation height of leaflets with potentially reduced longevity of the THV. Therefore, this approach should be only used in patients who present at increased or prohibitive risk for SAVR, since results of the surgical approach for large aortic annuli are excellent and long‐term results are documented 24 …”

The Effect of Surgical Aortic Valve Replacement on Arterial Stiffness: Does the Valve Type Matter?

“…The analysis included patients who underwent isolated SAVR or SAVR with cardiopulmonary bypass grafting (CABG) and returned for follow-up after one year. With AVS as the primary cause, patients received an MV, BV, or SV prosthesis depending on international criteria and their individual condition (Figure 1) [7]. The study design consisted of 3 different time points: baseline, at discharge (4-9 days after SAVR), and at 1 year.…”

“…The complexity of AVS and its impact on both the LV and the vessels make managing the disease challenging. While transcatheter aortic valve implantation (TAVI) is gaining popularity and is increasingly being used in clinical practice [5,6], SAVR remains a preferred option for many patients with AVS, particularly those who are younger and at lower surgical risk [7][8][9].…”

Editorial: Heart valve diseases: from molecular mechanisms to clinical implications

“…Mechanical valves are made of synthetic materials, whereas biological heart valves are made of tissues and valves derived from animals or human donors. As a part of the post-surgery treatment, the mechanical or biological prosthesis valve must be analyzed to confirm the correct function, usually using echocardiography ( Sigala et al, 2023 ).…”