Long-Term Results of Aortic Valve Replacement in Nonelderly Adults: Mechanical vs. Biological Valve

Background: Aortic valve replacement (AVR) is the established treatment for aortic valve stenosis (AS). In nonelderly adults, mechanical valve prostheses are typically preferred due to the limited longevity of biological valve prostheses. This study's objective was to assess the long-term results and quality of life following AVR in patients under the age of 60, and to make a comparison between mechanical (mech-AVR) and biological prosthesis (bio-AVR) outcomes.

Methods: A total 721 consecutive patients younger than 60 years who received. AVR at our institution between January 2005 and December 2018 were included. Primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) and secondary endpoints were survival, aortic valve reintervention.

Results: Biological prosthesis was implanted in 560 (78%) patients, whereas a mechanical was used in 161 (22%) patients. Mean age at the time of index AVR surgery was significantly higher in the bio-AVR group compared to mech-AVR (p < 0.001). Landmark analysis by using an adjusted cox-model until 5 years, showed that COPD (HR 2.17; 95% CI 1.23–3.85; p = 0.008), dialysis (HR 4.21; 95% CI 1.97–9.00; p < 0.001), EuroSCORE II (HR 1.10; 95% CI 1.05–1.15; p < 0.001) and endocarditis (HR 2.61; 95% CI 1.55–4.38; p < 0.001) had significant impact on MACCE events. After 5 years, endocarditis still had a significant impact on MACCE rate (p = 0.027). Further, landmark analysis revealed no differences in MACCE rate between mech-AVR vs. bio-AVR until 5 years postoperatively (p = 0.973). Beginning with 5 years postoperatively, bio-AVR had a significantly higher MACCE rate (HR 0.09; 95% CI 0.02–0.50; p = 0.006). Survival was comparable in both study subgroups. Survival was influenced by concomitant coronary artery disease (HR 2.53; p < 0.001), dialysis (HR 5.02; p < 0.001), EuroSCORE II (HR 1.09; p < 0.001) and endocarditis (HR 3.09; p < 0.001). At follow-up, physical QoL was similar (p = 0.195) but mental QoL was worse after bio-AVR (p < 0.001).

Conclusion: In nonelderly adults, opting for tissue aortic valve replacement is linked to a notably increased rate of MACCE five years after the procedure, as well as diminished long-term mental quality of life. The selection of the aortic valve prosthesis, however, does not seem to affect long-term survival. Nevertheless, the incidence of MACCE remains elevated, particularly within the bio-AVR group and therefore aortic valve repair and Ross procedure should be considered in this young patient cohort.

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Artikel online veröffentlicht:
13. Februar 2024