Valve replacement in young adults resulted in 15-year survival rates of 80.1% after AVR and 71.5% after MVR, with equivalent late survival between bioprosthetic and mechanical valves.
Cohort (n=500)
Does bioprosthetic valve replacement improve survival, functional status, and quality of life compared to mechanical valve replacement in young adults (age 18-50) undergoing AVR or MVR?
In young adults undergoing valve replacement, bioprostheses offer equivalent long-term survival to mechanical valves but are associated with better physical capacity and lower disability, particularly in the aortic position.
OBJECTIVES: To examine the multiple impacts of valve replacement on the lives of young adults. METHODS: Patients (N=500) between age 18 and 50 who had aortic valve replacement (AVR) and/or mitral valve replacement (MVR) with contemporary prostheses were followed annually. Events, functional status, and quality of life were examined with regression models. RESULTS: Median follow-up was 7.1+/-5.3 years (maximum 26.7 years). Five, 10, and 15-year survival was 92.7+/-1.7, 88.3+/-2.4 and 80.1+/-4.7% after AVR, and 93.1+/-2.3, 79.5+/-4.3 and 71.5+/-5.4% after MVR, respectively. Survival decreased with concomitant coronary disease (hazard ratio (HR): 4.5) and preoperative LV grade (HR: 2.0/grade increase) in AVR patients, and with atrial fibrillation (HR: 5.5), coronary disease (HR: 5.7), preoperative left atrial diameter (HR: 3.0/cm increase) and NYHA class (HR: 2.1/class increase) in MVR patients. Despite reoperation, late survival was equivalent between bioprostheses and mechanical valves in both implant positions. The ten-year cumulative incidence of embolic stroke was 6.3+/-2.4% for mechanical AVR patients, 6.4+/-2.9% for bioprosthetic AVR patients, 12.7+/-3.9% for mechanical MVR patients, and 3.1+/-3.1% for bioprosthetic MVR patients. Atrial fibrillation (HR: 2.8) and smoking (HR: 4.0) were risk factors for stroke in MVR patients. In AVR patients, SF-12 physical scores, freedom from recurrent heart failure, and freedom from disability were significantly higher in bioprosthetic than mechanical valve patients. Career or income limitations were more often subjectively linked to a mechanical prosthesis in both implant positions. CONCLUSIONS: Late outcomes of modern prosthetic valves in young adults remain suboptimal. Bioprostheses deserve consideration in the aortic position, as mechanical valves are associated with lower physical capacity, a higher prevalence of disability, and poorer disease perception. Early surgical referral and atrial fibrillation surgery may improve survival after MVR.
Ruel et al. (2004) conducted a cohort in Aortic and/or mitral valve disease requiring replacement (n=500). Valve replacement with contemporary prostheses vs. Mechanical vs bioprosthetic valves was evaluated on Survival, events, functional status, and quality of life. Valve replacement in young adults resulted in 15-year survival rates of 80.1% after AVR and 71.5% after MVR, with equivalent late survival between bioprosthetic and mechanical valves.