A single-center study on prosthesis selection strategy in aortic valve replacement for patients aged 50-65 years

The optimal valve type for middle-aged AVR patients remains debated with inconsistent guideline recommendations. To explore valve selection strategy for 50- to 65-year-old undergoing aortic valve replacement (AVR) by comparing long-term outcomes of mechanical vs. biological artificial valves, with age stratification (≤60/>60 years) to guide clinical decisions.

A retrospective cohort study analyzed 341 patients (2009-2016) undergoing valve replacement surgery, categorized into mechanical valve (n=155) and biological valve (n=186) groups. Propensity score matching (PSM) (1:1) was performed in the overall cohort, as well as in the <60- and ≥60-year subgroups to balance baselines confouders. We regarded all-cause mortality as the primary endpoint while major adverse cardiovascular events (MACEs) served as the secondary endpoint. Univariate and multivariate analyses identified prognostic factors.

After PSM, In the overall cohort, mechanical valve recipients had significantly longer MACE-free survival [hazard ratio (HR) =2.007, P=0.004] vs. bioprosthetic recipients, driven by lower new-onset arrhythmia (HR =1.822, P=0.02). No significant difference in overall survival was observed. Notably, the incidence of MACE showed an increasing trend with age in the bioprosthetic valve group, whereas no such trend was observed in the mechanical valve group. For patients <60 years, overall survival did not differ pre-/after-PSM. Mechanical recipients had superior MACE-free survival (after-PSM HR =2.025, P=0.04), mainly due to fewer new-onset arrhythmias (HR =1.904, P=0.03). For patients ≥60 years, no significant differences were found in overall survival, MACE-free survival, or reoperation-free survival between groups.

For patients aged 50- to 65-years-old who require AVR, overall and MACE-free survival is comparable between mechanical and biological valves. Mechanical valves are associated with more favorable MACE-free survival in those under 60 years of age, but individualized selection remains crucial.