Tissue versus mechanical aortic valve replacement in younger patients: A multicenter analysis

Area of Science:

• Cardiovascular Surgery
• Biomaterials Science
• Clinical Outcomes Research

Background:

• Aortic valve replacement (AVR) is a critical procedure for patients with aortic valve disease.
• Choosing between tissue and mechanical AVR prostheses involves balancing long-term durability and reoperation risk.
• Patient age, particularly between 50 and 65 years, influences prosthesis selection and long-term outcomes.

Purpose of the Study:

• To compare the long-term survival rates of patients aged 50-65 who received either tissue or mechanical aortic valve replacement.
• To evaluate differences in morbidity, mortality, and reoperation rates between the two types of AVR prostheses in this age group.

Main Methods:

• A multicenter, retrospective analysis of 9,388 AVR patients from 1991-2015 was conducted.
• A propensity score-weighted cohort of 1,449 patients (840 tissue, 609 mechanical) aged 50-65 undergoing isolated AVR was analyzed.
• Primary endpoint was all-cause mortality; secondary endpoints included morbidity, mortality, length of stay, and reoperation risk.

Main Results:

• No significant difference in major in-hospital morbidity, mortality, or length of hospitalization was observed between tissue and mechanical valves.
• Adjusted 15-year survival showed no significant difference between mechanical and tissue valves (HR, 0.87; 95% CI, 0.67-1.13).
• Tissue valves were associated with a significantly higher cumulative incidence of reoperation (19.1%) compared to mechanical valves (3.0%).

Conclusions:

• In patients aged 50-65 undergoing AVR, prosthesis type (tissue vs. mechanical) does not impact adjusted long-term survival.
• Tissue valves demonstrate a higher risk of reoperation compared to mechanical valves in this patient cohort.
• The findings support shared decision-making regarding AVR prosthesis choice, considering the trade-off between reoperation risk and other factors.