Key result
Biological SAVR models are linked to a ~22% absolute difference in ten-year survival without reintervention.
Why the study?
To compare long-term outcomes across different models of mechanical and biological aortic valve prostheses after surgical aortic valve replacement in the Netherlands.
Do long-term survival and freedom from reintervention differ across different models of mechanical and biological aortic valve prostheses in adults undergoing isolated primary SAVR?
Cohort (n=13,262)
Yes
Do long-term survival and freedom from reintervention differ across different models of mechanical and biological aortic valve prostheses in adults undergoing isolated primary SAVR?
Significant differences exist in 10-year survival and freedom from reintervention among different biological and mechanical aortic valve prosthesis models used in real-world practice.
Model-specific survival differences after SAVR require cautious interpretation; leaves open causal effects and optimal selection.
Objectives To compare long-term outcomes across different models of mechanical and biological aortic valve prostheses after surgical aortic valve replacement (SAVR) in the Netherlands. Methods Data from the Netherlands Heart Registration on isolated, primary SAVR procedures performed from 2007 to 2018 in adult patients were used, excluding active endocarditis. Ten-year survival and freedom from valve-related reintervention were estimated for models that were implanted >200 times, using Cox proportional hazards models for survival and Fine and Gray’s models with death as the competing-event for freedom of reintervention. Results For 11,139 patients treated with a biological prosthetic aortic valve, ten-year survival was highest for the Perimount Magna Ease (72.6%) and Epic (70.0%), and significantly lower for the Perimount Magna (65.1%), Trifecta (63.1%), Perimount (61.4%), Freedom Solo (51.5%), and Mitroflow (50.7%). Ten-year freedom from reintervention was highest for the Perimount Magna (99.3%), and significantly lower for the Perimount Magna Ease (98.2%), Perimount (98.2%), Epic (97.3%), Trifecta (96.8%), Freedom Solo (93.2%) and Mitroflow (90.5%). For 2,123 patients treated with a mechanical prosthetic aortic valve, ten-year survival was highest for the Regent (91.2%) and not significantly different for the Open Pivot (89.2%), Slimline (87.5%), HP (87.3%) and significantly lower for the Carbomedics Reduced (87.0%). Ten-year freedom from reintervention was highest for the Carbomedics Reduced (97.1%), not significantly different for the Open Pivot (96.1%), Slimline (96.5%), Regent (95.9%), and significantly lower for the HP (94.9%). Conclusions Differences in ten-year outcomes after SAVR were observed for the different prosthetic aortic valve models that were used in the Netherlands Heart Registration, especially for biological prosthetic aortic valve models, with survival varying from 50.7% to 72.6% and freedom from reintervention from 90.5% to 99.3%.
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Beaufort et al. (2026) conducted a cohort in Surgical aortic valve replacement (n=13,262). Different models of mechanical and biological aortic valve prostheses vs. Other prosthetic valve models was evaluated on Ten-year survival and freedom from valve-related reintervention. Ten-year survival and freedom from reintervention after surgical aortic valve replacement varied significantly across prosthetic models, with biological valve survival ranging from 50.7% to 72.6%.
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