A1 Refereed original research article in a scientific journal
Mechanical versus biological prostheses for surgical aortic valve replacement in patients aged 50-70
Authors: Ville Kytö, Jussi Sipilä, Elina Ahtela, Päivi Rautava, Jarmo Gunn
Publisher: Little, Brown & Co.
Publication year: 2019
Journal: Annals of Thoracic Surgery
Journal name in source: The Annals of thoracic surgery
Journal acronym: Ann Thorac Surg
ISSN: 0003-4975
eISSN: 1552-6259
DOI: https://doi.org/10.1016/j.athoracsur.2019.10.027
Abstract
Background
Usage of biological prosthesis is increasing in surgical aortic valve replacement (SAVR). Recent U.S. guidelines recommend either biological or mechanical prosthesis for SAVR in patients aged 50-70 years. We set out to study long-term outcomes of mechanical vs. biological prosthetic valves in this patient group.
Methods
All patients (excluding infective endocarditis and other concomitant surgery than CABG) aged 50-70 with first-time SAVR in Finland between 2004-2014 were retrospectively studied (n=2928). Propensity score matching (1:1) was used to identify patients with comparable baseline features (n=1152). Outcomes were 10-year all-cause mortality, aortic valve re-operation, major bleeding, ischemic stroke, and infective endocarditis. Mean follow-up was 6.7 years.
Results
Ten-year all-cause mortality was 18.6% with mechanical and 27.6% with biological valve (HR 0.72; CI 0.54-0.97, p=0.028). Prosthetic valve re-operation was performed in 1.4% with mechanical and in 8.5% with bioprosthetic valves (HR 0.30; CI 0.12-0.74; p=0.009). Major bleeding occurred to 21.5% with mechanical and to 16.9% with biological prostheses (HR 1.19; p=0.402). Rates of intracranial bleeding were also comparable. Ischemic stroke rates within 10-years were 12.7% with mechanical and 9.3% with biological valves (HR 1.29; p=0.316). Infective endocarditis occurred in 3.7% of mechanical and in 7.3% of biological valves (HR 0.46; CI 0.24-0.88; p= 0.018).
Conclusions
Mechanical valve prostheses were associated with lower mortality, lower rates of re-operation, and lower occurrence of infective endocarditis compared to bioprostheses within 10-years after SAVR in matched patients aged 50-70. Our results do not support the routine use of biological valve prostheses in this patient group.
Background
Usage of biological prosthesis is increasing in surgical aortic valve replacement (SAVR). Recent U.S. guidelines recommend either biological or mechanical prosthesis for SAVR in patients aged 50-70 years. We set out to study long-term outcomes of mechanical vs. biological prosthetic valves in this patient group.
Methods
All patients (excluding infective endocarditis and other concomitant surgery than CABG) aged 50-70 with first-time SAVR in Finland between 2004-2014 were retrospectively studied (n=2928). Propensity score matching (1:1) was used to identify patients with comparable baseline features (n=1152). Outcomes were 10-year all-cause mortality, aortic valve re-operation, major bleeding, ischemic stroke, and infective endocarditis. Mean follow-up was 6.7 years.
Results
Ten-year all-cause mortality was 18.6% with mechanical and 27.6% with biological valve (HR 0.72; CI 0.54-0.97, p=0.028). Prosthetic valve re-operation was performed in 1.4% with mechanical and in 8.5% with bioprosthetic valves (HR 0.30; CI 0.12-0.74; p=0.009). Major bleeding occurred to 21.5% with mechanical and to 16.9% with biological prostheses (HR 1.19; p=0.402). Rates of intracranial bleeding were also comparable. Ischemic stroke rates within 10-years were 12.7% with mechanical and 9.3% with biological valves (HR 1.29; p=0.316). Infective endocarditis occurred in 3.7% of mechanical and in 7.3% of biological valves (HR 0.46; CI 0.24-0.88; p= 0.018).
Conclusions
Mechanical valve prostheses were associated with lower mortality, lower rates of re-operation, and lower occurrence of infective endocarditis compared to bioprostheses within 10-years after SAVR in matched patients aged 50-70. Our results do not support the routine use of biological valve prostheses in this patient group.
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