Tissue versus mechanical aortic valve replacement in younger patients: A multicenter analysis.

Publisher: Mosby Country of Publication: United States NLM ID: 0376343 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-685X (Electronic) Linking ISSN: 00225223 NLM ISO Abbreviation: J Thorac Cardiovasc Surg Subsets: MEDLINE

Publication: St. Louis, MO : Mosby
Original Publication: St. Louis.

Bioprosthesis* ; Heart Valve Prosthesis*; Aortic Valve/*surgery ; Heart Valve Diseases/*surgery ; Heart Valve Prosthesis Implantation/*instrumentation; Age Factors ; Aged ; Aortic Valve/diagnostic imaging ; Aortic Valve/physiopathology ; Female ; Heart Valve Diseases/diagnostic imaging ; Heart Valve Diseases/mortality ; Heart Valve Diseases/physiopathology ; Heart Valve Prosthesis Implantation/adverse effects ; Heart Valve Prosthesis Implantation/mortality ; Humans ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications/mortality ; Postoperative Complications/surgery ; Prosthesis Design ; Recovery of Function ; Registries ; Reoperation ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome ; United States

Objective: The goal of this study was to examine the long-term survival of patients between the ages of 50 and 65 years who underwent tissue versus mechanical aortic valve replacement (AVR) in a multicenter cohort.
Methods: A multicenter, retrospective analysis of all AVR patients (n = 9388) from 1991 to 2015 among 7 medical centers reporting to a prospectively maintained clinical registry was conducted. Inclusion criteria were: patients aged 50 to 65 years who underwent isolated AVR. Baseline comorbidities were balanced using inverse probability weighting for a study cohort of 1449 AVRs: 840 tissue and 609 mechanical. The primary end point of the analysis was all-cause mortality. Secondary end points included in-hospital morbidity, 30-day mortality, length of stay, and risk of reoperation.
Results: During the study period, there was a significant shift from mechanical to tissue valves (P < .001). There was no significant difference in major in-hospital morbidity, mortality, or length of hospitalization. Also, there was no significant difference in adjusted 15-year survival between mechanical versus tissue valves (hazard ratio, 0.87; 95% confidence interval [CI], 0.67-1.13; P = .29), although tissue valves were associated with a higher risk of reoperation with a cumulative incidence of 19.1% (95% CI, 14.4%-24.3%) versus 3.0% (95% CI, 1.7%-4.9%) for mechanical valves. The reoperative 30-day mortality rate was 2.4% (n = 2) for the series.
Conclusions: Among patients 50 to 65 years old who underwent AVR, there was no difference in adjusted long-term survival according to prosthesis type, but tissue valves were associated with a higher risk of reoperation.
(Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Comment in: J Thorac Cardiovasc Surg. 2019 Dec;158(6):1536-1538. (PMID: 30929983)
Comment in: J Thorac Cardiovasc Surg. 2019 Dec;158(6):1541-1542. (PMID: 30981519)
Comment in: J Thorac Cardiovasc Surg. 2019 Dec;158(6):1539-1540. (PMID: 31280895)

Keywords: bioprosthesis adverse effects; heart valve diseases; heart valve prosthesis adverse effects; mortality; survival analysis

Date Created: 20190402 Date Completed: 20200302 Latest Revision: 20200302

20231215

10.1016/j.jtcvs.2019.02.076

30929984