Evaluating Reference Ages for Selecting Prosthesis Types for Heart Valve Replacement in Korea.

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Gerontology

Background:

• Patient age is a key factor in choosing heart valve prostheses, but clinical guidelines vary.
• Objective age indicators are crucial for selecting between mechanical and biologic prostheses in valve replacement surgery.

Purpose of the Study:

• To investigate age-specific survival differences between mechanical and biologic prostheses in aortic valve replacement (AVR) and mitral valve replacement (MVR).
• To analyze the association between prosthesis type, recipient age, and long-term outcomes including mortality and valve-related events.

Main Methods:

• A nationwide cohort study utilizing Korean National Health Insurance Service data (2003-2018).
• Included patients undergoing AVR or MVR, employing inverse-probability-of-treatment-weighting to mitigate selection bias.
• Compared all-cause mortality and valve-related events (reoperation, thromboembolism, bleeding) across age groups.

Main Results:

• For AVR, bioprostheses showed higher mortality than mechanical in patients <55 and 55-64 years, but lower mortality in those ≥65 years.
• For MVR, bioprostheses had higher mortality in patients 55-69 years, with no difference for those ≥70 years.
• Reoperation risk was consistently higher with bioprostheses for both AVR and MVR across all age strata. Thromboembolism and bleeding risks were higher with mechanical AVR in older patients (≥65 years).

Conclusions:

• Mechanical prostheses provide a long-term survival advantage over bioprostheses up to age 65 for AVR and age 70 for MVR.
• Bioprosthetic valves are associated with a higher risk of reoperation regardless of age or valve position.
• Age remains a critical factor in prosthesis selection, influencing survival and complication risks.