Long-term outcomes following aortic valve replacement in bioprosthetic vs mechanical valves

Background

Aortic valve disease(AVD) accounts for 33 % of valvular heart disease(VHD) but causes over 60 % of VHD mortality. For surgical AVR, mechanical valves are recommended for patients <50 years old and bioprosthetic valves for those >70 years old.

Objectives

To investigate the long-term differences following AV replacement(AVR) comparing bioprosthetic and mechanical valves in patients aged 50–70.

Methods

4,927 patients underwent AVR, 744 of which were propensity-matched 2:1 for bioprosthetic and mechanical valves. Outcomes included mortality, morbidity, and rates of reoperation.

Results

The average age of the propensity-matched groups was 57 and 56.7 years, and female sex accounted for 26.4 % and 25.0 % for the bioprosthetic and mechanical valve groups, respectively. Other baseline demographics and comorbidities were similar between the groups. There were no deaths at 30 days and complication rates did not differ between groups(p > 0.05). Mortality at 1, 5, and 15 years was similar between groups. Reoperation rates at 5 and 10 years did not significantly differ between bioprosthetic and mechanical valves(p = 0.84, p = 0.31), although at 15-year follow-up, patients with bioprosthetic valves were more likely to require reoperation(21.2 % versus 9.7 %, adjusted hazard ratio 3.65, 95 % confidence interval 1.07–12.5, p = 0.0.39).

Conclusions

Patients receiving AVR from 50 to 70 years old have similar long-term outcomes irrespective of whether they received bioprosthetic or mechanical valves, with only reoperation being significantly different at 15 years follow-up. With low rates of reoperation, mortality, and avoidance of anticoagulation, bioprosthetic valves are a reasonable option for patients 50–70 years old, although mechanical valves still provide a durability benefit for young patients.