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Aortic valve replacement with mechanical vs. biological prostheses in patients aged 50–69 years

Natalie Glaser, Veronica Jackson, Martin J. Holzmann, Anders Franco-Cereceda, Ulrik Sartipy
DOI: http://dx.doi.org/10.1093/eurheartj/ehv580 ehv580 First published online: 11 November 2015

Abstract

Aims The objective was to investigate the long-term all-cause mortality in patients aged 50–69 years after aortic valve replacement (AVR) with bioprosthetic or mechanical valves.

Methods and results All patients aged 50–69 years who had undergone AVR in Sweden 1997–2013 were identified from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies register. Subsequent patient-level record linkage with national health-data registers provided patient characteristics, vital status, and clinical outcomes. Of the 4545 patients, 60% (2713/4545) had received mechanical valves and 40% (1832/4545) bioprostheses. In 1099 propensity score-matched patient pairs, 16% (180/1099) had died in the mechanical valve group and 20% (217/1099) in the bioprosthetic group; mean follow-up 6.6 (maximum 17.2) years. Survival was higher in the mechanical than in the bioprosthetic group: 5-, 10-, and 15-year survival 92, 79, and 59% vs. 89, 75, and 50%; hazard ratio 1.34; 95% confidence interval (CI) 1.09–1.66; P = 0.006. There was no difference in stroke [subdistribution hazard ratio (sHR) 1.04; 95% CI 0.72–1.50, P = 0.848]; however, the risk for aortic valve reoperation was higher (sHR 2.36; 95% CI 1.42–3.94, P = 0.001), and for major bleeding lower (sHR 0.49; 95% CI 0.34–0.70, P < 0.001), in patients who had received bioprostheses than in those with mechanical valves.

Conclusion Patients aged 50–69 years who received mechanical valves had better long-term survival after AVR than those with bioprostheses. The risk of stroke was similar; however, patients with bioprostheses had a higher risk of aortic valve reoperation and a lower risk of major bleeding.

Clinical Trial Registration http://clinicaltrials.gov/show/NCT02276950.

ClinicalTrials.gov Identifier NCT02276950.

  • Aortic valve replacement
  • Cardiac surgery
  • Middle-aged
  • Mechanical valve
  • Bioprosthesis
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