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Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement
Andrew B Goldstone1, Peter Chiu1, Michael Baiocchi1
1From the Departments of Cardiothoracic Surgery (A.B.G., P.C., B.L., W.L.P., M.P.F., Y.J.W.) and Health Research and Policy (A.B.G., P.C.) and the Stanford Prevention Research Center, Department of Medicine (M.B.), School of Medicine, Stanford University, Stanford, CA.
The New England Journal of Medicine
|November 9, 2017
Summary
Mechanical valves show long-term survival benefits over biologic valves for aortic and mitral valve replacement in younger patients. This finding contrasts with the increasing use of biologic prostheses despite limited supporting evidence.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Outcomes Research
Background:
- Mechanical and biologic prostheses are used for aortic and mitral valve replacement.
- Biologic prostheses are increasingly favored, yet evidence supporting this trend is limited.
Purpose of the Study:
- To compare long-term mortality and adverse event rates between mechanical and biologic prostheses.
- To analyze outcomes stratified by age and valve position (aortic vs. mitral).
Main Methods:
- Inverse-probability-weighted analysis of patients undergoing primary valve replacement (1996-2013).
- Comparison of mechanical vs. biologic prostheses in different age strata.
- Evaluation of mortality, reoperation, stroke, and bleeding rates.
Main Results:
- Biologic prosthesis use significantly increased from 1996-2013.
- Biologic prostheses were associated with higher 15-year mortality in specific younger age groups for both aortic and mitral valve replacement.
- Reoperation rates were higher with biologic prostheses; bleeding and stroke rates were higher with mechanical prostheses in some groups.
Conclusions:
- Mechanical prostheses offer a long-term mortality benefit compared to biologic prostheses up to age 70 for mitral and 55 for aortic valve replacement.
- The findings challenge the trend towards biologic prosthesis use in younger patients.
- Evidence supports mechanical valve use in younger populations for improved long-term survival.
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