Tissue versus mechanical aortic valve replacement in younger patients: A multicenter analysis

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 158; no. 6; pp. 1529 - 1538.e2
• Main Authors: Iribarne, Alexander, Leavitt, Bruce J., Robich, Michael P., Sardella, Gerald L., Gelb, Daniel J., Baribeau, Yvon R., McCullough, Jock N., Weldner, Paul W., Clough, Robert A., Ross, Cathy S., Malenka, David J., DiScipio, Anthony W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2019
• Subjects: Age Factors; Aged; Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve - surgery; Bioprosthesis; bioprosthesis adverse effects; Female; heart valve diseases; Heart Valve Diseases - diagnostic imaging; Heart Valve Diseases - mortality; Heart Valve Diseases - physiopathology; Heart Valve Diseases - surgery; Heart Valve Prosthesis; heart valve prosthesis adverse effects; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - mortality; Humans; Length of Stay; Male; Middle Aged; mortality; Postoperative Complications - mortality; Postoperative Complications - surgery; Prosthesis Design; Recovery of Function; Registries; Reoperation; Retrospective Studies; Risk Factors; survival analysis; Time Factors; Treatment Outcome; United States; United States; SSA; bioprosthesis adverse effects; NNECDSG; survival analysis; CI; mortality; heart valve diseases; HR; heart valve prosthesis adverse effects; AVR
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2019.02.076

The goal of this study was to examine the long-term survival of patients between the ages of 50 and 65 years who underwent tissue versus mechanical aortic valve replacement (AVR) in a multicenter cohort. A multicenter, retrospective analysis of all AVR patients (n = 9388) from 1991 to 2015 among 7 medical centers reporting to a prospectively maintained clinical registry was conducted. Inclusion criteria were: patients aged 50 to 65 years who underwent isolated AVR. Baseline comorbidities were balanced using inverse probability weighting for a study cohort of 1449 AVRs: 840 tissue and 609 mechanical. The primary end point of the analysis was all-cause mortality. Secondary end points included in-hospital morbidity, 30-day mortality, length of stay, and risk of reoperation. During the study period, there was a significant shift from mechanical to tissue valves (P < .001). There was no significant difference in major in-hospital morbidity, mortality, or length of hospitalization. Also, there was no significant difference in adjusted 15-year survival between mechanical versus tissue valves (hazard ratio, 0.87; 95% confidence interval [CI], 0.67-1.13; P = .29), although tissue valves were associated with a higher risk of reoperation with a cumulative incidence of 19.1% (95% CI, 14.4%-24.3%) versus 3.0% (95% CI, 1.7%-4.9%) for mechanical valves. The reoperative 30-day mortality rate was 2.4% (n = 2) for the series. Among patients 50 to 65 years old who underwent AVR, there was no difference in adjusted long-term survival according to prosthesis type, but tissue valves were associated with a higher risk of reoperation.