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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
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Mechanical aortic valve replacement in non-elderly adults: meta-analysis and microsimulation
Nelleke M Korteland1, Jonathan R G Etnel1, Bardia Arabkhani1
1Department of Cardiothoracic Surgery, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
European Heart Journal
|October 19, 2017
Summary
Mechanical aortic valve replacement (AVR) in non-elderly adults shows suboptimal survival and significant risks of bleeding and reintervention. Shared decision-making is crucial for patients selecting prosthetic valves, considering all options.
Area of Science:
- Cardiovascular Surgery
- Prosthetic Valve Technology
- Clinical Outcomes Research
Background:
- Mechanical aortic valve replacement (AVR) is an option for non-elderly adults.
- Decision-making for prosthetic valve selection requires comprehensive outcome data.
Purpose of the Study:
- To provide a detailed overview of outcomes after contemporary mechanical AVR in non-elderly adults (age 18-55).
- To support informed prosthetic valve selection through evidence-based estimates.
Main Methods:
- Systematic review of publications from 1995-2015 reporting clinical outcomes after bileaflet mechanical AVR.
- Meta-analysis of pooled outcomes and microsimulation modeling for life expectancy and lifetime event risk.
- Inclusion of 29 publications with 5728 patients and 32,515 patient-years of follow-up.
Main Results:
- Pooled early mortality was 3.15%, with a late mortality rate of 1.55%/year (38.7% valve-related).
- Annual event rates included thromboembolism (0.90%), major bleeding (0.85%), and reintervention (0.51%).
- A 45-year-old patient had an estimated life expectancy of 19 years and lifetime risks of 18% (thromboembolism), 15% (bleeding), and 10% (reintervention).
Conclusions:
- Mechanical AVR in non-elderly adults is associated with suboptimal survival and significant lifetime risks.
- Anticoagulation-related complications and reoperation are considerable concerns.
- Shared decision-making is essential, presenting evidence-based risks and benefits of mechanical and biological valves.
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