Ten-Year Long-Term Analysis of Mechanical and Biological Aortic Valve Replacement

Abstract

Background For patients undergoing aortic valve replacement (AVR), structural valve deterioration (SVD) of a bioprosthesis (BP) is substantially accelerated in younger patients and valve-in-valve implantation is not always a considerable option. The risk–benefit assessment between SVD versus the risk of bleeding and thromboembolic events in patients with a mechanical prosthesis (MP) resulted in an age limit shift irrespective of inconsistent results reported in literature.

Method This retrospective single-center study compared 10-year long-term outcomes in patients undergoing isolated AVR with MP or BP. The risk-adjusted comparison of patients undergoing isolated AVR (n = 121) was performed after 1:1 propensity score matching (PSM) for age, sex, endocarditis, and chronic renal impairment (caliper of 0.2) leading to 29 pairs. Short- and long-term outcomes with respect to reoperation, major bleeding, stroke, all-cause and cardiovascular mortality, and overall survival at 10 years were analyzed.

Results After PSM, groups were comparable with respect to preoperative characteristics, including patients with a mean age of 65 ± 3 years (MP) and 66 ± 4 years (BP) and an incidence rate of 6.9% for infective endocarditis in both cohorts. Short-term outcomes (transient neurologic disorder = 0.0 vs. 6.9%; stroke = 0.0%; in-hospital mortality = 3.4%) and in-hospital stays were comparable between MP and BP.

Conclusion After isolated AVR with MP and BP, 10-year long-term outcomes were comparable in the reported single-center cohort. MP can still be implanted safely without a disadvantage as regards long-term survival.

Keywords

aortic valve replacement - mechanical valve - biological valve

Authors' Contribution

K.E. and E.K. contributed to study design, data collection, data analysis and interpretation, and writing of the manuscript; both authors contributed equally to this work. I.D. contributed to data collection and data analysis/ interpretation. G.S., P.R., N.M., and T. W. contributed to data analysis and interpretation, review, and correction of the manuscript.

^* These authors share first authorship.

Publikationsverlauf

Eingereicht: 26. November 2021

Angenommen: 02. Februar 2022

Artikel online veröffentlicht:
06. Juni 2022

• References

• 1 Wang N, Tsai YC, Niles N. et al. Transcatheter aortic valve implantation (TAVI) versus sutureless aortic valve replacement (SUAVR) for aortic stenosis: a systematic review and meta-analysis of matched studies. J Thorac Dis 2016; 8 (11) 3283-3293
• 2 Schnittman SR, Adams DH, Itagaki S, Toyoda N, Egorova NN, Chikwe J. Bioprosthetic aortic valve replacement: revisiting prosthesis choice in patients younger than 50 years old. J Thorac Cardiovasc Surg 2018; 155 (02) 539-547.e9
• 3 Head SJ, Çelik M, Kappetein AP. Mechanical versus bioprosthetic aortic valve replacement. Eur Heart J 2017; 38 (28) 2183-2191
• 4 Jamieson WR, Ling H, Burr LH. et al. Carpentier-Edwards supraannular porcine bioprosthesis evaluation over 15 years. Ann Thorac Surg 1998; 66 (6, Suppl): S49-S52
• 5 Nishimura RA, Otto CM, Bonow RO. et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation 2017; 135 (25) e1159-e1195
• 6 Baumgartner H, Falk V, Bax JJ. et al; ESC Scientific Document Group. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 2017; 38 (36) 2739-2791
• 7 Rodríguez-Caulo EA, Macías D, Adsuar A. et al. Biological or mechanical prostheses for isolated aortic valve replacement in patients aged 50-65 years: the ANDALVALVE study. Eur J Cardiothorac Surg 2019; 55 (06) 1160-1167
• 8 Brown ML, Schaff HV, Lahr BD. et al. Aortic valve replacement in patients aged 50 to 70 years: improved outcome with mechanical versus biologic prostheses. J Thorac Cardiovasc Surg 2008; 135 (04) 878-884 , discussion 884
• 9 Kytö V, Sipilä J, Ahtela E, Rautava P, Gunn J. Mechanical versus biologic prostheses for surgical aortic valve replacement in patients aged 50 to 70. Ann Thorac Surg 2020; 110 (01) 102-110
• 10 Kytö V, Myllykangas ME, Sipilä J, Niiranen TJ, Rautava P, Gunn J. Long-term outcomes of mechanical vs biologic aortic valve prosthesis in patients older than 70 years. Ann Thorac Surg 2019; 108 (05) 1354-1360
• 11 Roumieh M, Ius F, Tudorache I. et al. Comparison between biological and mechanical aortic valve prostheses in middle-aged patients matched through propensity score analysis: long-term results. Eur J Cardiothorac Surg 2015; 48 (01) 129-136
• 12 Oxenham H, Bloomfield P, Wheatley DJ. et al. Twenty year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses. Heart 2003; 89 (07) 715-721
• 13 Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J Am Coll Cardiol 2000; 36 (04) 1152-1158
• 14 Chiang YP, Chikwe J, Moskowitz AJ, Itagaki S, Adams DH, Egorova NN. Survival and long-term outcomes following bioprosthetic vs mechanical aortic valve replacement in patients aged 50 to 69 years. JAMA 2014; 312 (13) 1323-1329
• 15 Brown JM, O'Brien SM, Wu C, Sikora JA, Griffith BP, Gammie JS. Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database. J Thorac Cardiovasc Surg 2009; 137 (01) 82-90
• 16 Roskell NS, Samuel M, Noack H, Monz BU. Major bleeding in patients with atrial fibrillation receiving vitamin K antagonists: a systematic review of randomized and observational studies. Europace 2013; 15 (06) 787-797
• 17 Roudaut R, Serri K, Lafitte S. Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations. Heart 2007; 93 (01) 137-142
• 18 Garkina SV, Vavilova TV, Lebedev DS, Mikhaylov EN. Compliance and adherence to oral anticoagulation therapy in elderly patients with atrial fibrillation in the era of direct oral anticoagulants. J Geriatr Cardiol 2016; 13 (09) 807-810
• 19 Zhao DF, Seco M, Wu JJ. et al. Mechanical versus bioprosthetic aortic valve replacement in middle-aged adults: a systematic review and meta-analysis. Ann Thorac Surg 2016; 102 (01) 315-327
• 20 Vitanova K, Wirth F, Boehm J, Burri M, Lange R, Krane M. Surgical aortic valve replacement-age-dependent choice of prosthesis type. J Clin Med 2021; 10 (23) 10
• 21 Davierwala PM, Borger MA, David TE, Rao V, Maganti M, Yau TM. Reoperation is not an independent predictor of mortality during aortic valve surgery. J Thorac Cardiovasc Surg 2006; 131 (02) 329-335
• 22 Banbury MK, Cosgrove III DM, White JA, Blackstone EH, Frater RW, Okies JE. Age and valve size effect on the long-term durability of the Carpentier-Edwards aortic pericardial bioprosthesis. Ann Thorac Surg 2001; 72 (03) 753-757
• 23 Reynolds MR, Magnuson EA, Wang K. et al; PARTNER Trial Investigators. Health-related quality of life after transcatheter or surgical aortic valve replacement in high-risk patients with severe aortic stenosis: results from the PARTNER (Placement of AoRTic TraNscathetER Valve) Trial (Cohort A). J Am Coll Cardiol 2012; 60 (06) 548-558
• 24 Webb JG, Murdoch DJ, Alu MC. et al. 3-year outcomes after valve-in-valve transcatheter aortic valve replacement for degenerated bioprostheses: the PARTNER 2 registry. J Am Coll Cardiol 2019; 73 (21) 2647-2655
• 25 Eghbalzadeh K, Kuhn EW, Sabashnikov A. et al. Latest generation of balloon-expandable valve, the Edwards Sapien 3 valve: less paravalvular regurgitation but higher transvalvular pressure gradients. Thorac Cardiovasc Surg 2019; 67 (04) 236-242
• 26 Puskas JD, Gerdisch M, Nichols D. et al; PROACT Investigators. Anticoagulation and antiplatelet strategies after On-X mechanical aortic valve replacement. J Am Coll Cardiol 2018; 71 (24) 2717-2726