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The fate of bioprostheses in middle-aged patients: the Japanese experience
Hiroshi Tanaka1, Yutaka Okita, Hitoshi Kasegawa
1National Cardiovascular Center, Department of Cardiovascular Surgery, 5-7-1, Fujishirodai, Suita, Osaka, Japan. hirtanak@hsp.ncvc.go.jp
Insights
Bioprosthetic heart valves show poor long-term durability in middle-aged patients, with higher rates of structural valve deterioration (SVD) in the mitral position. Reoperation is often necessary, emphasizing patient-surgeon preference in prosthesis selection.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Outcomes Research
Background:
- Bioprosthesis use is increasing, but long-term durability in middle-aged patients remains understudied.
- Current bioprosthetic valves have not been adequately evaluated for longevity in patients under 60 years old.
Purpose of the Study:
- To assess the long-term fate and durability of bioprosthetic heart valves in patients younger than 60 years.
- To determine rates of structural valve deterioration (SVD) and reoperation in this demographic.
Main Methods:
- A retrospective analysis of 944 bioprostheses implanted between 1975 and 2005 across 43 Japanese centers.
- Data collected included patient age, valve type, implant position (aortic or mitral), follow-up duration, and reasons for reoperation.
- Actuarial methods were used to calculate freedom from SVD and reoperation rates.
Main Results:
- The 15-year freedom from SVD was 39% for aortic and 27% for mitral positions (p=0.004).
- Freedom from reoperation at 15 years was 31% for aortic and 24% for mitral positions (p=0.178).
- New-generation valves demonstrated superior durability compared to older models (p=0.05).
Conclusions:
- Bioprosthetic valves exhibit unfavorable long-term freedom from SVD in middle-aged patients, necessitating awareness of likely reoperation.
- Patient-surgeon preference should guide bioprosthesis selection, considering the limited durability in this age group.
Background And Aim Of The Study:
Although the trend of bioprosthesis use has been evaluated extensively, the durability of currently available bioprostheses has not been determined in middle-aged patients. The study aim was to determine the long-term fate of bioprostheses implanted in patients aged < 60 years.
Methods:
Valve implantation data were collected from 43 centers in Japan. The data included patient age at implantation, type of valve, implant position, follow up period, and cause of reoperation including structural valve deterioration (SVD) and non-SVD. Between 1975 and 2005, a total of 697 bioprostheses was implanted in the mitral position, and 247 in the aortic position. The mean follow up period was 9.2 years. Rates of freedom from SVD and reoperation were determined using an actuarial method.
Results:
The mean age at implantation was 45 +/- 10.9 years. The 15-year freedom from SVD was 39% for those with valves implanted in the aortic position, and 27% in the mitral position (p = 0.004). For the same period, the actuarial freedom from reoperation was 31% for valves in the aortic position, and 24% in the mitral position (p = 0.178). The difference in actuarial freedom from SVD was not significant between age groups in the mitral position. However, there were differences in actuarial freedom from SVD in the aortic position for patients aged < 10 years when compared to the other age groups (p < 0.001). New-generation valves showed better long-term durability than older valves (p = 0.05).
Conclusion:
The long-term freedom from SVD in middle-aged patients was unfavorable for bioprostheses implanted in the aortic and mitral positions. Middle-aged patients must be made aware that reoperation will be necessary; consequently, the choice of bioprosthesis should be dictated by patient-surgeon preference.
