Abstract
Background This study aims to compare the outcomes after aortic valve replacement (AVR) with
mechanical and biological valves in middle-aged patients (55–65 years) to determine
the impact on long-term mortality and morbidity.
Methods A retrospective analysis of 373 patients between 55 and 65 years of age who received
a primary AVR with or without concomitant coronary artery bypass graft between April
1995 and March 2014. Propensity matching yielded 118 patient pairs in the mechanical
and biological valve cohorts.
Results Median follow-up time was 6.9 years. No differences in long-term survival or a composite
outcome of stroke, bleeding, and endocarditis (major adverse prosthesis-related event;
MAPE) were observed in patients receiving biological versus mechanical valves. Actuarial
15-year survival was 46.4% (95% confidence interval [CI], 28.8–62.3%) in the biological
valve group versus 60.6% (95% CI, 47.5–71.4%) in the mechanical valve group (hazard
ratio, 1.16 [95%CI, 0.69–1.94], p = 0.58). The 15-year cumulative incidence of MAPE was 53.3% (95% CI, 33.7–69.4%)
for biological valves versus 24.5% (95% CI, 16.2–33.8%) for mechanical valves (hazard
ratio, 0.65 [95% CI, 0.37–1.14], p = 0.12). The 15-year cumulative incidence of reoperation was higher in the bioprosthetic
group (26.0% [95% CI, 14.0–39.8%] vs. 5.4% [95% CI, 2.0–11.4%]; hazard ratio 0.24
[95% CI, 0.09–0.68] p < 0.01).
Conclusion There is no difference in survival and MAPE at 15 years between biological and mechanical
valves. The risk of reoperation was significantly higher in the biological valve group
and may affect valve choice in middle-aged patients.
Keywords
aortic valve replacement - CABG - heart valve prosthesis - outcomes - propensity matching
