Change of Paradigm? Ten-year Outcome of Aortic Pericardial Tissue Valves in Patients Younger than 50 Years of Age - is the „Bio“-Trend Justified?

Objectives: Biological valve prostheses become more and more favored for aortic valve replacement (AVR) in patients below 60 years of age and the shift toward an even younger patient group is ongoing and actively discussed.

The aim of this study is to evaluate the outcome of biological aortic valve replacement in patients under 50 years of age to determine whether the increasing use of bioprostheses for these patients is justified.

Methods: From January 2005 to December 2014, 80 patients younger than 50 years of age at the time of surgery, who underwent isolated biological aortic valve replacement were retrospectively analyzed. The mean follow-up was 64 ± 34 months (range 15–125). Mean age at implantation was 43.8 ± 7.2 years.

Results: Survival was 100%. At the end of follow-up, freedom from all valve-related complications was 78.1% in all patients. Complications as structural valve degeneration occurred in 18.8%, endocarditis of the bioprosthesis in 3.1%, with need for re-operation in 15.6% of all patients. Transcatheter valve-in-valve implantation was the therapy of choice in 6.3% of patients with structural valve degeneration and subsequent heart failure with highly reduced ejection fraction.

Conclusion: The increasing quality and durability of aortic pericardial tissue valves and the progression in the field of transcatheter approaches which can be offered as a subsequent treatment in case of valve degeneration may be supportive facts for the trend toward bioprostheses in young patients. However, the present study with a patient population aged below 50 years of age at time of surgery shows that rates of valve related complications and need for reoperation / reintervention are significantly high. Therefore, the decision for implantation of aortic bioprostheses should be taken very carefully in young patients.