Key result
Mechanical aortic valve replacement showed comparable 10-year long-term outcomes and survival compared to biological prostheses in a propensity-matched cohort.
Why the study?
The risk-benefit assessment between bioprosthesis structural valve deterioration and mechanical prosthesis bleeding or thromboembolic risk has driven an age limit shift despite inconsistent literature.
Does mechanical prosthesis compared to biological prosthesis improve 10-year outcomes in patients undergoing isolated aortic valve replacement?
Cohort (n=121)
No
Does mechanical prosthesis compared to biological prosthesis improve 10-year outcomes in patients undergoing isolated aortic valve replacement?
Mechanical and biological aortic valve replacements show comparable 10-year outcomes in this matched cohort, suggesting mechanical valves remain a safe option without long-term survival disadvantage.
Comparable short-term outcomes may inform prosthesis selection in younger AVR patients; leaves open long-term durability for prospective trials.
BACKGROUND: For patients undergoing aortic valve replacement (AVR), structural valve deterioration (SVD) of a bioprosthesis (BP) is substantially accelerated in younger patients and valve-in-valve implantation is not always a considerable option. The risk-benefit assessment between SVD versus the risk of bleeding and thromboembolic events in patients with a mechanical prosthesis (MP) resulted in an age limit shift irrespective of inconsistent results reported in literature. METHOD: = 121) was performed after 1:1 propensity score matching (PSM) for age, sex, endocarditis, and chronic renal impairment (caliper of 0.2) leading to 29 pairs. Short- and long-term outcomes with respect to reoperation, major bleeding, stroke, all-cause and cardiovascular mortality, and overall survival at 10 years were analyzed. RESULTS: After PSM, groups were comparable with respect to preoperative characteristics, including patients with a mean age of 65 ± 3 years (MP) and 66 ± 4 years (BP) and an incidence rate of 6.9% for infective endocarditis in both cohorts. Short-term outcomes (transient neurologic disorder = 0.0 vs. 6.9%; stroke = 0.0%; in-hospital mortality = 3.4%) and in-hospital stays were comparable between MP and BP. CONCLUSION: After isolated AVR with MP and BP, 10-year long-term outcomes were comparable in the reported single-center cohort. MP can still be implanted safely without a disadvantage as regards long-term survival.
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Eghbalzadeh et al. (2022) conducted a cohort in Aortic valve replacement (n=121). Mechanical aortic valve replacement vs. Biological aortic valve replacement was evaluated on 10-year overall survival and clinical outcomes (reoperation, major bleeding, stroke, mortality). Mechanical aortic valve replacement showed comparable 10-year long-term outcomes and survival compared to biological prostheses in a propensity-matched cohort.
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