Association between surgical aortic valve replacement and long-term outcomes in 50 to 65-year-olds: Results of the AUTHEARTVISIT study

Objectives During the last years, age recommendations for the use of biological prostheses rather than mechanical prostheses for surgical aortic valve replacement (sAVR) have been lowered considerably. We evaluated survival rates, major adverse cardiac events (MACEs), and reoperation risks after surgical (sM-AVR) and biological (sB-AVR) AVR, to provide data for the optimal prosthesis choice for middle aged patients between 50 and 65 years. Methods We performed a population-based cohort study using Austrian Health System data from 2010–2020. Patients undergoing isolated sAVR (n=3761) were categorized into sM-AVR (n=1018) and sB-AVR (n=2743) groups. Propensity score matching (PSM) was applied to balance covariates. The primary endpoint was all-cause mortality. Secondary endpoints included MACEs, reoperation, stroke, bleeding, and survival post-reoperation. Outcomes were assessed using Cox regression and Kaplan-Meier analyses. Results Patients undergoing sM-AVR had significantly lower all-cause mortality compared to sB-AVR (HR=1.352, p=0.003). sB-AVR was associated with higher risks of MACEs (HR=1.182, p=0.03) and reoperation (HR=2.338, p=0.002). Stroke and bleeding rates were comparable. All results were sustained after PSM. Conclusion The findings highlight increased mortality, MACEs and reoperation risks associated with sB-AVR compared to sM-AVR. We observed superior long-term outcomes after sM-AVR, suggesting the need to reevaluate the expanding use of sB-AVR in younger patients.