Reoperation in Bioprosthetic vs Mechanical Aortic Valve Replacement in The Society of Thoracic Surgeons Database

The choice between bioprosthetic and mechanical surgical aortic valve replacement (AVR) should balance individual valve durability with patient life expectancy and the need for future reintervention. To inform clinical practice, this study aimed to evaluate contemporary, real-world, long-term outcomes of AVR reoperation and survival from The Society of Thoracic Surgeons Adult Cardiac Surgery Database.

All patients undergoing primary isolated bioprosthetic or mechanical AVR were identified. The database was used to define subsequent valve reoperation and link to the National Death Index for all-cause mortality (2008-2019). Patients aged >80 years, with endocarditis, emergency/salvage status, shock, ejection fraction ≤25%, any prior cardiac surgery, and nonlinkage to the National Death Index were excluded. Robust risk-adjustment was performed using age-specific stabilized inverse probability weighting and restricted cubic splines to model nonlinear age relationships.

During the study period, 140,516 patients underwent bioprosthetic (n = 122,453) or mechanical (n = 18,063) AVR. A total of 29,048 underwent aortic valve reoperation (n = 2991) or died during the study period. After risk adjustment, freedom from reoperation or all-cause mortality favored mechanical valves to age 63 years, was equivalent between 63 and 72 years, and was superior in bioprosthetic AVR for age 72 years or older. Age group-specific analyses demonstrated mechanical valves to be associated with lower reoperation or all-cause mortality in all age groups ≤65 years.

In patients aged ≤63 years, mechanical AVR was associated with lower risk-adjusted reoperation or all-cause mortality compared with bioprosthetic AVR. These contemporary long-term data further inform patient and provider shared clinical decision-making when choosing a prosthetic aortic valve.