Aortic valve replacement and long-term prognosis

Area of Science:

• Cardiology
• Cardiac Surgery
• Biomedical Engineering

Background:

• Aortic valve replacement (AVR) is a critical procedure for severe aortic valve disease.
• Choosing between mechanical and biological AVR prostheses involves balancing durability and long-term risks.
• Understanding long-term mortality associated with each AVR type is essential for clinical decision-making.

Purpose of the Study:

• To assess and compare the long-term mortality risks associated with mechanical versus biological aortic valve replacement (AVR).

Main Methods:

• Systematic review of literature published in the last decade focusing on AVR mortality data and long-term follow-up (≥5 years).
• Analysis of mortality data using a mortality ratio (MR) comparing observed to expected mortality from country-specific life tables.
• Inclusion of data from large series and recent cardiology and cardiac surgery textbooks.

Main Results:

• Mortality ratios (MR) after AVR ranged from 120%–350% for mechanical and 100%–300% for bioprosthetic valves, varying with age at surgery.
• AVR before age 50 was associated with MRs exceeding 400%, indicating significantly higher mortality.
• No significant difference in MR was observed between mechanical and biological AVR in patients over 50 years old.
• Independent prognostic factors for mortality post-AVR include age, NYHA class, LVEF, atrial fibrillation, and valve lesion characteristics.

Conclusions:

• There is no significant difference in excess long-term mortality between mechanical and biological aortic valve replacement.
• Aortic valve replacement performed before the age of 50 is associated with increased mortality, irrespective of the prosthesis type.