Key result
New-generation mechanical valves were associated with significantly lower cardiac-related mortality (P=0.047) and hemorrhagic events (P=0.032) compared to old mechanical valves.
Why the study?
Do new-generation mechanical valves improve late clinical outcomes compared to old mechanical valves in patients with severe aortic stenosis?
Cohort (n=254)
Do new-generation mechanical valves improve late clinical outcomes compared to old mechanical valves in patients with severe aortic stenosis?
p-value: p=0.047
New-generation mechanical prostheses for severe aortic stenosis demonstrate better hemodynamic performance, lower incidence of prosthesis-patient mismatch, and reduced cardiac mortality and hemorrhagic events compared to older valves.
BACKGROUND: The study aimed to evaluate the late clinical outcomes of new-generation mechanical valves for severe aortic stenosis (AS) compared with old mechanical valves. METHODS: We retrospectively reviewed data from 254 patients with severe AS, who underwent primary mechanical aortic valve replacement from 1995 to 2013. Patients were classified into two groups: old-valve group (n=65: 33 ATS standard, 32 Medtronic-Hall) and new-valve group (n=189: 113 St. Jude Regent, 46 On-X, 30 Sorin Overline). Median patient age was 58 years (Q1-Q3: 52-61). With propensity score matching based on demographic information, 56 patients in the old-valve group were matched with 177 patients in the new-valve group. The median follow-up duration was 91 months (Q1-Q3: 48-138). RESULTS: Cardiac-related mortality and hemorrhagic events were significantly lower in the new-valve group (P=0.047 and P=0.032, respectively). The median international normalized ratio (INR) at follow-up was significantly higher in the old-valve group [2.23, Q1-Q3: 2.14-2.35 (old-valve group); 2.08, Q1-Q3: 1.92-2.23 (new-valve group), P<0.001]. The incidence of prosthesis-patient mismatch (PPM) was significantly higher in the old-valve group (P<0.001). Multivariate analysis of the total population revealed that PPM was a significant risk factor for cardiac-related events [hazard ratio (HR) =5.279, 95% CI, 1.886-14.561, P=0.002] and showed higher trend of increasing mortality (HR =3.082, P=0.076). CONCLUSIONS: New mechanical prostheses showed a better hemodynamic performance and lower incidence of PPM. Anticoagulation strategy to lower the target INR in patients with new mechanical valves may improve late outcomes by reducing hemorrhagic events.
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Lee et al. (2018) conducted a cohort in Severe aortic stenosis (n=254). New-generation mechanical valves vs. Old mechanical valves was evaluated on Cardiac-related mortality (p=0.047). New-generation mechanical valves were associated with significantly lower cardiac-related mortality (P=0.047) and hemorrhagic events (P=0.032) compared to old mechanical valves.
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