Long-Term Outcome after Biological Aortic Valve Replacement in Young Adults

Objectives: Aortic valve replacement (AVR) is the standard of care for treatment of aortic valve stenosis (AS). In young adults, mechanical valve prostheses are recommended due to limited durability of biological valve prostheses. The aim of the study was to evaluate the long-term outcome after biological AVR in patients younger than 60 years.

Methods: A total 354 consecutive patients younger than 60 years who received an elective biological aortic valve at our institution between January 2005 and December 2015 were included. Sixty-nine patients with acute endocarditis were excluded. Follow-up protocol included clinical interview using a structured questionnaire and long-term echocardiographic follow-up. Primary end points were cardiovascular death, aortic valve reoperation, and major adverse cardiac events (MACE), and secondary end points were max/mean gradients across tissue prosthesis.

Results: Mean age at the time of index AVR surgery was 52.3 ± 7.1 (range: 24–59; 75% male). Predominant AS was present in 70% patients and preoperative left ventricular ejection fraction was 54.4 ± 10.5%. EuroSCORE II was 1.502 (0.56–19.82). Long-term follow-up was available in 90.1% (78.7 ± 38.1 months, range: 24–152 months). Overall survival at 5, 10, and 12 years was 88.0, 82.2, and 81.0%. Freedom from redo AVR surgery was 97.6, 94.3, and 91.6%, and freedom from MACE was 95.2, 89.5, and 86.0%, respectively. Max and mean gradient at follow-up was 31 ± 18 and 18 ± 11 mm Hg. Post hoc analysis between endocarditis subgroup and primary study cohort showed a significantly lower survival (50.8 vs. 81.0%; p < 0.001), freedom from redo AVR surgery (75 vs. 91.6%; p < 0.001) and freedom from MACE of 50.0 vs. 85.5% (p < 0.001) in the endocarditis cohort. Cox regression analysis revealed endocarditis (odds ratio [OR] 3.440; p < 0.001), preoperative creatinine (OR: 1.494; p = 0.001), and EuroSCORE II (OR: 1.256; p = 0.027) as independent predictors for survival.

Conclusion: Biological AVR in patients younger than 60 years results in good long-term survival and freedom from adverse cardiac events. However, long-term prognosis is significantly worse in the AVR patients undergoing surgery due to acute endocarditis.

No conflict of interest has been declared by the author(s).