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Updated: Jul 15, 2026
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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
A single-center study on prosthesis selection strategy in aortic valve replacement for patients aged 50-65 years
Journal of Thoracic Disease
|July 14, 2026
Summary
For middle-aged patients undergoing aortic valve replacement (AVR), mechanical valves offer better major adverse cardiovascular event (MACE)-free survival, especially for those under 60. However, overall survival remains comparable between mechanical and biological valves.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Outcomes Research
Background:
- Aortic valve replacement (AVR) in middle-aged patients (50-65 years) lacks consistent guideline recommendations for optimal valve selection.
- Debate persists regarding the long-term efficacy of mechanical versus biological artificial valves in this demographic.
Purpose of the Study:
- To compare long-term outcomes of mechanical versus biological artificial valves in patients aged 50-65 undergoing AVR.
- To stratify outcomes by age (≤60 and >60 years) to inform clinical decision-making for valve selection.
Main Methods:
- Retrospective cohort study of 341 AVR patients (2009-2016), divided into mechanical (n=155) and biological (n=186) valve groups.
- Propensity score matching (1:1) applied to the overall cohort and age subgroups (<60, ≥60 years) to balance baseline characteristics.
- Primary endpoint: all-cause mortality. Secondary endpoint: major adverse cardiovascular events (MACE).
Main Results:
- Post-matching, mechanical valves showed significantly better MACE-free survival (HR=2.007, P=0.004) than bioprosthetic valves, primarily due to lower new-onset arrhythmia.
- No significant difference in overall survival was observed between valve types in the overall cohort.
- In patients <60 years, mechanical valves demonstrated superior MACE-free survival (HR=2.025, P=0.04).
- No significant differences in survival or reoperation-free survival were found between valve types in patients ≥60 years.
- MACE incidence trended higher with age in the bioprosthetic group but not the mechanical group.
Conclusions:
- Overall and MACE-free survival are comparable between mechanical and biological valves for AVR patients aged 50-65.
- Mechanical valves are associated with improved MACE-free survival in patients under 60.
- Individualized valve selection remains critical for optimizing AVR outcomes in middle-aged patients.
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