Long-Term Durability and Valve Integrity of Aortic Valve Bioprostheses: Single-Center Experience with Patients under 50 Years of Age

Objectives: There is no consensus for the lower age limit of bioprosthesis in aortic position for surgical aortic valve replacement (SAVR) and current available long-term data is insufficient. The objective of this retrospective analysis is to add clinical echocardiographic evidence and provide decision guidance for the choice of an age-appropriate prosthesis in patients younger than 50 years.

Methods: From January 2000 to December 2017, a total of 3,519 patients underwent isolated SAVR with a biological prosthesis at our institution. A total of 120 patients younger than 50 years at the time of surgery were identified, of whom 95 patients contributed follow-up data. Data were retrospectively analyzed, including clinical and echocardiographic assessment. Mean follow-up was 8 ± 4.4 years with a maximum of 19 years and a total of 677 valve years.

Results: Mean age at the time of surgery was 41 ± 8.6 years. Eighty-three percent of patients were male. There was no perioperative mortality. Mean diameter of implanted bioprostheses was 25 ± 2.1 mm. Six patients died during follow-up (6.3%). Structural valve deterioration (SVD) occurred in 22 patients (23.2%), followed by redo surgical aortic valve replacement with a bioprosthesis in 11 patients, mechanical prosthesis in 8 patients, and transcatheter valve-in-valve implantations in 3 patients, respectively. Other major adverse cardiac events including endocarditis and thromboembolic events were seen in 16.3% of patients.

Conclusion: In the present cohort of patients < 50 years of age, new-generation bioprostheses provide satisfying results for bleeding and thromboembolic events, hemodynamic performance, and SVD. The inherent need for repeat valve intervention in young adults remains the major drawback for bioprostheses. Further large-number studies and randomized long-term outcome in younger cohorts are mandatory to substantiate whether this practice is justified.