What is the clinical evidence from this study?

Study design: Systematic Review. Population: aortic valve replacement (n=2686). Intervention: Bioprosthetic aortic valve replacement. Primary outcome: structural valve deterioration (95% CI 1.21-2.10).

What does this research mean for the field?

Bioprosthetic aortic valve replacement in nonelderly adults is associated with high rates of structural valve deterioration and reintervention, leading to high lifetime reoperation risks and impaired life expectancy compared with the general population. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 1, 2019Circulation Cardiovascular Quality and OutcomesOpen Access

Bioprosthetic Aortic Valve Replacement in Nonelderly Adults

Q: What question did this study set out to answer?

To comprehensively evaluate clinical outcomes after bioprosthetic aortic valve replacement in nonelderly adults and model age-specific lifetime event risks.

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Key result

Bioprosthetic AVR in nonelderly adults linked to ~1.6% annual structural valve deterioration and frequent reintervention.

95% CI 1.21-2.10
n=2,686

Why the study?

To support decision-making in aortic valve replacement in nonelderly adults by providing a comprehensive overview of outcomes after bioprosthetic AVR and estimating age-specific outcomes.

What are the long-term clinical outcomes and life expectancy after bioprosthetic aortic valve replacement in nonelderly adults?

Population

2686 patients with mean age <55 years undergoing bioprosthetic aortic valve replacement

Design

Systematic review and microsimulation model

Follow-up

Pooled mean 7.9±4.2 years

Authors

JEJonathan R.G. EtnelErasmus MC SHSimone HuygensCross-Cutting Cardiology PGPepijn GrashuisErasmus University Rotterdam

Discussion

Member takes

Implication

Bioprosthetic AVR in nonelderly adults links to high lifetime reintervention risk and reduced survival; leaves open optimal valve choice pending randomized comparisons.

Key Points

To comprehensively evaluate clinical outcomes after bioprosthetic aortic valve replacement in nonelderly adults and model age-specific lifetime event risks.
Conducted a systematic review of 19 publications (2000–2016) evaluating currently available bioprostheses in patients with a mean age <55 years (N=2,686; 21,117 patient-years; pooled mean follow-up: 7.9±4.2 years; pooled mean age: 50.7±11.0 years).
Entered pooled event rates and time-to-event data into a microsimulation model to estimate life expectancy and lifetime complications for ages 25, 35, 45, and 55 years at surgery.
Pooled early mortality was 3.30% (95% CI, 2.39–4.55), with late mortality of 2.39%/year (95% CI, 1.13–2.94), reintervention of 1.82%/year (95% CI, 1.31–2.52), and structural valve deterioration of 1.59%/year (95% CI, 1.21–2.10).
Pooled 20-year actuarial survival was 58.7% and freedom from reintervention was 29.0%, with median time to structural deterioration of 17.3 years and median time to first reintervention of 16.9 years.
Microsimulation for a 45-year-old adult estimated a life expectancy of 21 years (versus 32 years in the general population), alongside lifetime risks of 78% for reintervention and 71% for structural deterioration.

Study Design

Type

Systematic Review (n=2,686)

Structured PICO

What are the long-term clinical outcomes and life expectancy after bioprosthetic aortic valve replacement in nonelderly adults?

Population

2,686 nonelderly adults (pooled mean age 50.7 years) undergoing bioprosthetic aortic valve replacement, followed for a pooled mean of 7.9 years.

Intervention

Bioprosthetic aortic valve replacement

Outcome

Clinical outcomes including early mortality, late mortality, reintervention, structural valve deterioration, thromboembolism, bleeding, endocarditis, and life expectancyhard clinical

Bioprosthetic aortic valve replacement in adults under 55 is associated with high lifetime risks of structural valve deterioration and reintervention, alongside impaired survival compared to the general population.

Cite This Study

Etnel et al. (2019) conducted a systematic review in aortic valve replacement (n=2,686). Bioprosthetic aortic valve replacement was evaluated on structural valve deterioration (95% CI 1.21-2.10). Bioprosthetic aortic valve replacement in nonelderly adults is associated with high rates of structural valve deterioration (1.59%/year) and reintervention (1.82%/year).

synapsesocial.com/papers/6aa8b1e772f784a6546bf985 https://doi.org/10.1161/circoutcomes.118.005481

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Implication

Bioprosthetic AVR in nonelderly adults links to high lifetime reintervention risk and reduced survival; leaves open optimal valve choice pending randomized comparisons.

Bioprosthetic Aortic Valve Replacement in Nonelderly Adults

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Bioprosthetic Aortic Valve Replacement in Nonelderly Adults

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

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