Prosthesis Selection for Aortic Valve Replacement With Concomitant Coronary Artery Bypass Grafting

Area of Science:

• Cardiovascular Surgery
• Biomaterials Science
• Clinical Outcomes Research

Background:

• The choice between biological and mechanical prostheses for aortic valve replacement (AVR) with concurrent coronary artery bypass grafting (CABG) remains debated.
• Investigating postoperative outcomes is crucial for optimizing patient management in this complex surgical scenario.

Purpose of the Study:

• To compare the long-term postoperative outcomes of biological versus mechanical prostheses in patients undergoing AVR with CABG.
• To evaluate differences in survival, stroke, reoperation, and bleeding events between the two prosthesis types.

Main Methods:

• A retrospective cohort analysis of 2485 patients (aged 50-69) undergoing AVR+CABG between 2002-2018 in Hubei province.
• Propensity score matching created 346 patient pairs comparing bioprosthetic and mechanical valve groups with a median follow-up of 6.5 years.
• Key endpoints included mortality, stroke, major bleeding, and reoperation, with specific attention to reoperation causes.

Main Results:

• No significant differences were found in overall survival, stroke incidence, or overall reoperation rates between bioprosthetic and mechanical valve groups.
• Bioprosthetic valves demonstrated a higher 15-year cumulative incidence of reoperation due to prosthesis failure/dysfunction (HR 2.72).
• Mechanical valves were associated with a significantly higher 15-year cumulative incidence of major bleeding events (HR 1.92).

Conclusions:

• While long-term survival and stroke incidence are comparable, mechanical valves increase bleeding risk, and bioprosthetic valves face durability concerns requiring reoperation.
• Further long-term studies with larger sample sizes are needed to definitively establish the optimal prosthesis choice for AVR+CABG in this age group.
• The study highlights a trade-off between bleeding risk and prosthesis durability, informing clinical decision-making for aortic valve prostheses.