Very Long-Term Survival Implications of Heart Valve Replacement With Tissue Versus Mechanical Prostheses in Adults <60 Years of Age

Abstract

Background-Several centers favor replacing a diseased native heart valve with a tissue rather than a mechanical prosthesis, even in younger adult patients. However, long-term data supporting this approach are lacking. We examined the survival implications of selecting a tissue versus a mechanical prosthesis at initial left-heart valve replacement in a cohort of adults Ͻ60 years of age who were followed for over 20 years. Methods and Results-Comorbid and procedural data were available from 6554 patients who underwent valve replacement at our institution over the last 35 years. Of these, 1512 patients contributed follow-up data beyond 20 years, of whom 567 were adults Ͻ60 years of age at first left-heart valve operation (mean survivor follow-up, 24.0Ϯ3.1 years). Late outcomes were examined with Cox regression. Valve reoperation, often for prostheses that are no longer commercially available, occurred in 89% and 84% of patients by 20 years after tissue aortic and mitral valve replacement, respectively, and was associated with a mortality of 4.3%. There was no survival difference between patients implanted with a tissue versus a mechanical prosthesis at initial aortic valve replacement (hazard ratio 0.95; 95% CI: 0.7, 1.3; Pϭ0.7). For mitral valve replacement patients, long-term survival was poorer than after aortic valve replacement (hazard ratio 1.4; 95% CI: 1.1, 1.8; Pϭ0.003), but again no detrimental effect was associated with use of a tissue versus a mechanical prosthesis (hazard ratio 0.9; 95% CI 0.5, 1.4; Pϭ0.5). Conclusions-In

Transcatheter Aortic Valve-in-Valve Implantation for Patients With Degenerative Surgical Bioprosthetic Valves

“…14 Structural deterioration of bioprostheses has been documented in 10-30% of survivors at 10 years, and 30-60% at 15 years. 4-6, 22 Early failure, however, is not rare. 23 The potential for earlier failure of surgical valves is evidenced by a relatively short median time to therapy in the global VIV registry of only 9 years (IQR, 6-12 years).…”

Tissue Heart Valve Replacement at BSMMU- Initial Experience with Two Cases

“…However, in some recent studies; researchers found that the 20-and 25-year survival rate in patients younger than age 50 did not differ between those who received tissue or mechanical devices. The findings show that at 20 years follow-up, the overall health risk of receiving a tissue valve is not greater than that of having a mechanical valve, even in young patients However; reoperation rates were significantly higher in patients receiving both aortic and mitral tissue valves 6,7 .…”

Aortic Valve Staphylococcus Aureus Endocarditis Complicated by Sinus of Valsalva-Right Atrial Fistula

“…In our patient, however, due to the aggressive and invasive nature of the Staphylococcus aureus the aortic annulus was completely destroyed and there was even evidence of an actual perforation through the leaflets. In patients less than 65 years of age mechanical valves have been shown to be much more durable with a lower incidence of primary valve failure compared to bioprosthetic valves [2], despite comparable overall mortality between the two options [3]. Reoperation rates are significantly higher for bioprosthetic valves, however longer survivals without additional surgery are expected with newer models [4].…”