Results of bioprosthetic versus mechanical aortic valve replacement performed with concomitant coronary artery bypass grafting (original) (raw)
JAMA, 2014
The choice between bioprosthetic and mechanical aortic valve replacement in younger patients is controversial because long-term survival and major morbidity are poorly characterized. To quantify survival and major morbidity in patients aged 50 to 69 years undergoing aortic valve replacement. Retrospective cohort analysis of 4253 patients aged 50 to 69 years who underwent primary isolated aortic valve replacement using bioprosthetic vs mechanical valves in New York State from 1997 through 2004, identified using the Statewide Planning and Research Cooperative System. Median follow-up time was 10.8 years (range, 0 to 16.9 years); the last follow-up date for mortality was November 30, 2013. Propensity matching yielded 1001 patient pairs. Primary outcome was all-cause mortality; secondary outcomes were stroke, reoperation, and major bleeding. No differences in survival or stroke rates were observed in patients with bioprosthetic compared with mechanical valves. Actuarial 15-year survival...
2021
Objectives: To compare 7-year survival and freedom from reoperation, as well as early clinical and hemodynamic outcomes, after surgical aortic valve replacement (SAVR) with mechanical or bioprosthetic valves in patients aged 50-70 years. Methods: single-center retrospective cohort study including adults aged 50-70 years who underwent SAVR in 2012 with a mechanical or bioprosthetic valve. Median follow-up was 7 years. Univariable analyses were performed using Kaplan- -Meier curves and Log-Rank tests for survival and freedom from reoperation analyses. Multivariable time-to-event analyses were conducted using Cox Regression. Results: Of a total of 193 patients, 76 (39.4%) received mechanical valves and 117 (60.6%) received bioprosthetic valves. A trend for better survival was found for mechanical prostheses when adjusting for EuroSCORE II (HR: 0.35; 95%CI: 0.12-1.02, p=0.054), but using a backward stepwise Cox regression prosthesis type was not retained by the model as an independent p...
The Journal of heart valve disease, 2006
Concomitant aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) is an established risk factor for diminished postoperative survival. Results from a VA population were reviewed in order to determine factors influencing early and late survival. Between 1993 and 2003, a total of 401 patients underwent AVR at the authors' institution. Of these patients, 249 (62%; mean age 70.6 years) had combined AVR and CABG. Surgical indications were primarily aortic valve pathology (group A: n = 168; 68%), primarily coronary artery disease (CAD) (group B: n = 55; 22%), and both severe aortic and coronary disease (group C: n = 26; 10%). In total, 177 patients (71%) received a bioprosthesis, and 72 (29%) received a mechanical valve. Short- and long-term outcomes were explored using univariate and multivariable hazard analyses. Overall operative mortality was 6.4%; mortality for groups A, B and C was 4.8%, 9.1% and 11.5%, respectively. On multivariable analysis, significant fac...
Prosthetic valve type for patients undergoing aortic valve replacement: a decision analysis 1 1 The
Ann Thorac Surg, 2000
Background. In two large, randomized, clinical trials long-term survival after aortic valve replacement (AVR) was similar for patients receiving tissue and mechanical aortic heart valve prostheses. Higher bleeding rates among patients with mechanical valves, who must receive permanent oral anticoagulation to prevent thromboembolism, were offset by higher reoperation rates for valve degeneration among patients with tissue valves. Because the average age of patients undergoing AVR and clinical practices have changed considerably since the randomized clinical trials were conducted, we performed a decision analysis to reassess the optimal valve type for patients undergoing AVR.
Surgical Aortic Valve Replacement—Age-Dependent Choice of Prosthesis Type
Journal of Clinical Medicine
Background: Recently, the use of surgically implanted aortic bioprostheses has been favoured in younger patients. We aimed to analyse the long-term survival and postoperative MACCE (Major Adverse Cardiovascular and Cerebral Event) rates in patients after isolated aortic valve replacement. Methods: We conducted a single-centre observational retrospective study, including all consecutive patients with isolated aortic valve replacement. 1:1 propensity score matching of the preoperative baseline characteristics was performed. Results: A total of 2172 patients were enrolled in the study. After propensity score matching the study included 428 patients: 214 biological vs. 214 mechanical prostheses, divided into two subgroups: group A < 60 years and group B > 60 years. The mean follow-up time was 7.6 ± 3.9 years. Estimated survival was 97 ± 1.9% and 89 ± 3.4% at 10 years for biological and mechanical prosthesis, respectively in group A (p = 0.06). In group B the survival at 10 years w...
Aortic valve replacement with biological prosthesis in patients aged 50–69 years
European Journal of Cardio-Thoracic Surgery, 2020
OBJECTIVES There is no consensus regarding the use of biological or mechanical prostheses in patients 50–69 years of age. Previous studies have reported a survival advantage with mechanical valves. Our goal was to compare the long-term survival of patients in the intermediate age groups of 50–59 and 60–69 years receiving mechanical or biological aortic valve prostheses. METHODS We conducted a retrospective analysis of patients in the age groups 50–59 years (n = 329) and 60–69 years (n = 648) who had a first-time isolated aortic valve replacement between 2000 and 2019. Kaplan–Meier and competing risk analyses were performed to compare survival, incidence of aortic valve reoperation, haemorrhagic complications and thromboembolic events for mechanical versus biological prostheses. RESULTS Patients aged 50–59 years with a biological prosthesis had a higher probability of aortic valve reintervention (26.3%, biological vs 2.6% mechanical; P < 0.001 at 15 years). The incidence of haem...
The Journal of heart valve disease
Cardiovascular risk factors have been associated with aortic valve stenosis, which is considered as an atherosclerosis-like process. The study aim was to assess the effect of cardiovascular risk factors on early and late outcome after valve replacement with a bioprosthesis for aortic stenosis (AS), and the impact of these factors on the outcome of the bioprosthesis. Preoperative clinical, biological and echocardiographic data were recorded in 222 patients (110 males, 112 females; mean age 73 +/- 8 years) who underwent surgery for severe AS between 1989 and 1993. The mean follow up was 7.3 +/- 4.7 years; total follow up was 1,621 patient-years (pt-yr). Overall 12-year actuarial survival rate was 36.1%. Independent predictors of mortality were age (hazards ratio (HR) 1.11; 95% CI: 1.08-1.14, p < 0.0001), diabetes mellitus (DM) (HR 2.53; 95% CI: 1.65-3.88, p < 0.0001), male gender (HR 2.17; 95% CI: 1.53-3.12, p < 0.0001), and NYHA class (HR 1.66; 95% CI: 1.17-2.34, p = 0.004)....
Circulation, 2007
Background— Several centers favor replacing a diseased native heart valve with a tissue rather than a mechanical prosthesis, even in younger adult patients. However, long-term data supporting this approach are lacking. We examined the survival implications of selecting a tissue versus a mechanical prosthesis at initial left-heart valve replacement in a cohort of adults <60 years of age who were followed for over 20 years. Methods and Results— Comorbid and procedural data were available from 6554 patients who underwent valve replacement at our institution over the last 35 years. Of these, 1512 patients contributed follow-up data beyond 20 years, of whom 567 were adults <60 years of age at first left-heart valve operation (mean survivor follow-up, 24.0±3.1 years). Late outcomes were examined with Cox regression. Valve reoperation, often for prostheses that are no longer commercially available, occurred in 89% and 84% of patients by 20 years after tissue aortic and mitral valve r...
Cureus
Aortic valve replacement (AVR) is a frequently performed procedure for treating aortic valvulopathy. AVR involves replacing the damaged aortic valve with either a mechanical or a bioprosthetic valve. While many factors are involved when selecting between the two options, age and patient preference are the deciding factors at this point. Mechanical valves demonstrate long-standing durability that overlaps with the accompanied bleeding risk due to lifetime anticoagulant therapy, making them a more favorable choice for younger patients. Bioprosthetic valves are preferred for older patients as they show a reduced risk of thrombogenicity. However, bioprosthetic valves have a higher incidence of structural valve degeneration (SVD) than mechanical valves. Our case report focuses on a 76-year-old patient who had undergone an AVR with a bioprosthetic valve at the age of 33, which has still not demonstrated any valve deterioration. As the longest known case of bioprosthetic durability, this patient provides useful data for designing bioprosthetic valves more resistant to structural degeneration and thereby better suited to younger patients or those at higher risk of bleeding.
Prosthetic Valve Type for Patients Undergoing Aortic Valve Replacement: A Decision Analysis
2010
Background. In two large, randomized, clinical trials long-term survival after aortic valve replacement (AVR) was similar for patients receiving tissue and mechanical aortic heart valve prostheses. Higher bleeding rates among patients with mechanical valves, who must re- ceive permanent oral anticoagulation to prevent throm- boembolism, were offset by higher reoperation rates for valve degeneration among patients with tissue valves. Because
Late incidence and determinants of reoperation in patients with prosthetic heart valves
European Journal of Cardio-Thoracic Surgery, 2004
Objectives: Reoperation is a relatively common event in patients with prosthetic heart valves, but its actual occurrence can vary widely from one patient to another. With a focus on bioprosthetic valves, this study examines risk factors for reoperation in a large patient cohort. Methods: Patients ðN ¼ 3233Þ who underwent a total of 3633 operations for aortic (AVR) or mitral valve replacement (MVR) between 1970 and 2002 were prospectively followed (total 21179 patient-years; mean 6.6^5.0 years; maximum 32.4 years). The incidence of prosthetic valve reoperation and the impact of patient-and valve-related variables were determined with actual and actuarial methods. Results: Fifteenyear actual freedom from all-cause reoperation was 94.1% for aortic mechanical valves, 61.4% for aortic bioprosthetic valves, 94.8% for mitral mechanical valves, and 63.3% for mitral bioprosthetic valves. In both aortic and mitral positions, current bioprosthesis models had significantly better durability than discontinued bioprostheses (15-year reoperation odds-ratio 0.11^0.04; P , 0:001 for aortic, and 0.42^0.14; P ¼ 0:009 for mitral). Current bioprostheses were significantly more durable in the aortic position than in the mitral position (14.3^6.8% more freedom from 15-year reoperation; P ¼ 0:018). Older age was protective, but smoking was an independent risk factor for reoperation after bioprosthetic AVR and MVR (hazard ratio for smoking 2.58 and 1.78, respectively). In patients with aortic bioprostheses, persistent left ventricular hypertrophy at follow-up and smaller prosthesis size predicted an increased incidence of reoperation, while this was not observed in patients with mitral bioprostheses. Conclusions: These analyses indicate that current bioprostheses have significantly better durability than discontinued bioprostheses, reveal a detrimental impact for smoking after AVR and MVR, and indicate an increased reoperation risk in patients with a small aortic bioprosthesis or with persistent left ventricular hypertrophy after AVR. q
The Journal of Thoracic and Cardiovascular Surgery, 2018
Background: In recent years, the use of surgically implanted biological aortic valves has been favored over mechanical prosthesis in patients between 50 and 70 years of age. However, outcomes on long-term survival are contradictory. The objective of this study was to determine if patients with mechanical valves have worse long-term survival than patients with biological prostheses. Methods: We systematically searched published studies that: (1) were propensity score-matched or randomized controlled trials; (2) provided survival data with a minimum follow-up of 5 years; and (3) included patients older than 50 and younger than 70 years of age. Review articles, case reports, and editorials were excluded. We conducted a meta-analysis on the basis of 2 types of analysis. A reconstruction of the database of each study to simulate a patient-level meta-analysis was performed. Log rank test of Kaplan-Meier curves was recalculated. Hazard ratio (HR) was calculated using a univariate Cox regression. In addition, we calculated a pooled HR using the fixed-effect inverse variance method. Results: Four propensity score-matched studies and 1 randomized controlled trial met the inclusion criteria. Data of 4686 patients were analyzed. Survival rates for mechanical versus biological valves at 10 and 15 years of follow-up were: 76.78% (95% confidence interval [CI], 74.72%-78.69%) versus 74.09% (95% CI, 71.96%-76.08%), and 61.58% (95% CI, 58.29%-64.69%) versus 58.04% (95% CI, 54.57%-61.35%). Log rank test was statistically significant (P ¼ .012) and the pooled HR was 0.86 (95% CI, 0.76-0.97; P ¼ .01). Conclusions: Compared with biological aortic valves, mechanical valves are associated with a long-term survival benefit for patients between 50 and 70 years.