Surgical Aortic Valve Replacement: Prosthesis Type Is Still a Topic of Discussion

Objectives: Recently, the use of surgically implanted aortic bioprostheses has been favored also in younger patients. We aimed to analyze the long-term survival and postoperative MACCE (major adverse cardiovascular and cerebral event) rates in patients after isolated aortic valve replacement using a mechanical or biological prosthesis.

Methods: We conducted a single-center observational retrospective study, including all consecutive patients with isolated aortic valve pathology, requiring surgical replacement of the valve. Concomitant surgical procedures and reoperations were excluded. 1:1 propensity score matching of the preoperative baseline characteristics was performed.

MACCE was defined as combined endpoint for 30-day mortality, AV reoperation, stroke and major bleeding, according to the VARC2 Consortium recommendations.

Result: A total of 2,172 patients were enrolled in the study. After propensity score matching, the study included 428 patients: 214 with biological and 214 with mechanical aortic valve prosthesis. The patients were divided into two subgroups according to the patients' age at surgery: group A < 60 years and group B > 60 years. The mean follow-up was 7.6 ± 3.9 years. In group A, estimated patients' survival for biological and mechanical prostheses was 97 ± 1.9% and 89 ± 3.4% at 10 years, respectively (log-rank p = 0.06). In group B, the survival rates at 10 years were 79.1 ± 5.8% and 69.8 ± 4.4%, respectively (log-rank p = 0.83). In group A, patients with bioprostheses (bio) showed a tendency for higher cumulative incidence MACCE rates compared with patients with mechanical prosthesis (mech) (bio 3.3 ± 1.8% vs. mech 2.3 ± 1.9% at 5 years, and bio 7.3 ± 5.3% vs. mech 4.6 ± 2.2% at 10 years). In group B, patients with mechanical prosthesis, a tendency for a higher cumulative incidence MACCE rates was observed (bio 0.9 ± 0.1% vs. mech 1.8 ± 1.3 at 5 years, and bio 4.3 ± 3.1% vs. mech 9.1 ± 3.1% at 10 years). The difference in both groups was not statistically significant (Gray's p = 0.83 for group A, and Gray's p = 0.86 for group B).

Conclusion: Long-term survival after surgical aortic valve replacement is similar in patients with biological and mechanical prostheses, independent of the patients' age. Moreover, patients <60 years with bioprostheses exhibited a survival benefit, compared with patients with mechanical prostheses in this age' group. The cumulative incidence rates for MACCE were similar between bioprosthesis and mechanical prosthesis in both groups. Hence, surgical aortic bioprostheses should be considered in patients <60 years as well.

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Artikel online veröffentlicht:
19. Februar 2021