Key result
Between 2002 and 2012, the use of mechanical valves in surgical aortic valve replacement decreased from 10.9% to 1.8% (p<0.001), alongside a significant increase in mean implanted valve size.
Cohort (n=3,172)
No
Absolute Event Rate: 1.8% vs 10.9%
p-value: p=<0.001
Over an 11-year period, the use of mechanical valves in sAVR significantly decreased while implanted valve sizes increased, reflecting a shift towards biological prostheses to preserve future transcatheter valve-in-valve options.
Objectives Biological prostheses for surgical aortic valve replacement (sAVR) are increasingly being considered in patients < 60 years of age. Likely, preserving the option of performing a transcatheter valve-in-valve (ViV) procedure in cases of structural valve deterioration has contributed to this development. We assessed the use pattern in sAVR over an 11-year period. Methods From 2002 through 2012, a total of 3,172 patients underwent sAVR at our center. Results Mean age was 70.4 ± 10.6 years and mortality was 1.9%. From 2002 to 2012, mean manufacturer given valve size increased from 22.8 ± 1.7 to 23.9 ± 2.0 mm (p < 0.001). Mean true internal diameter and effective orifice area increased from 19.6 to 20.3 mm (p = 0.027) and 1.41 to 1.56 cm(2) (p < 0.001), respectively. Use of mechanical valves decreased from 10.9 to 1.8% (p < 0.001), and patients were younger in 2012 than in 2002 (52.8 ± 16.5 vs. 41.0 ± 14.3 years; p = 0.028). Conclusion Profound change of use pattern in sAVR was observed as indication for biological prostheses became more liberal. Larger prostheses were implanted during the observational period. Especially in younger patients, optimal sizing is essential to preserve the option for subsequent ViV procedures.
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Treede et al. (2015) conducted a cohort in Surgical aortic valve replacement (n=3,172). Time period (2012) vs. Time period (2002) was evaluated on Use of mechanical valves (p=<0.001). Between 2002 and 2012, the use of mechanical valves in surgical aortic valve replacement decreased from 10.9% to 1.8% (p<0.001), alongside a significant increase in mean implanted valve size.
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