Long-Term Outcomes in Patients Undergoing Consecutive Bioprosthetic Aortic Valve Replacement

Area of Science:

• Cardiovascular Surgery
• Biomaterials Science
• Geriatric Cardiology

Background:

• Increasing use of bioprosthetic valves in the aortic position, driven by patient quality of life and younger patient selection.
• Emerging strategy of valve-in-valve transcatheter aortic valve implantation (TAVI) for failing bioprosthetic valves.
• Need to review outcomes for patients undergoing multiple bioprosthetic aortic valve replacements (AVRs).

Purpose of the Study:

• To review the authors' experience with patients undergoing consecutive bioprosthetic AVRs.
• To assess overall survival and freedom from a third or more AVR in this patient cohort.
• To provide data relevant to the increasing use of TAVI and valve-in-valve TAVI in younger populations.

Main Methods:

• Retrospective review of patients undergoing consecutive bioprosthetic AVRs at a single cardiothoracic surgical unit.
• Data extraction from prospective databases, electronic, and archived clinical records.
• Analysis of overall survival and freedom from subsequent AVRs, with identification of predictors for reintervention.

Main Results:

• 267 patients included with a mean follow-up of 22.3 years; median survival of 31.7 years.
• Concurrent cardiac procedures were common (65.2% for 2 AVRs, 79.8% for 3+ AVRs).
• Age at first AVR <45 years and at second AVR <56 years were optimal predictors for needing a third or more AVR.

Conclusions:

• Consecutive bioprosthetic AVRs demonstrate remarkably good overall survival.
• Findings are pertinent to the growing application of TAVI and valve-in-valve TAVI, especially in younger patients.
• The study offers encouraging data for repeated bioprosthetic valve use, considering the need for concurrent procedures.