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Eur Heart J. 2016 Sep 7;37(34):2658-67. doi: 10.1093/eurheartj/ehv580. Epub 2015 Nov 11.

Aortic valve replacement with mechanical vs. biological prostheses in patients aged 50-69 years.

Author information

1
Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm SE-171 76, Sweden Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
2
Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden.
3
Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm SE-171 76, Sweden Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden Ulrik.Sartipy@karolinska.se.

Abstract

AIMS:

The objective was to investigate the long-term all-cause mortality in patients aged 50-69 years after aortic valve replacement (AVR) with bioprosthetic or mechanical valves.

METHODS AND RESULTS:

All patients aged 50-69 years who had undergone AVR in Sweden 1997-2013 were identified from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies register. Subsequent patient-level record linkage with national health-data registers provided patient characteristics, vital status, and clinical outcomes. Of the 4545 patients, 60% (2713/4545) had received mechanical valves and 40% (1832/4545) bioprostheses. In 1099 propensity score-matched patient pairs, 16% (180/1099) had died in the mechanical valve group and 20% (217/1099) in the bioprosthetic group; mean follow-up 6.6 (maximum 17.2) years. Survival was higher in the mechanical than in the bioprosthetic group: 5-, 10-, and 15-year survival 92, 79, and 59% vs. 89, 75, and 50%; hazard ratio 1.34; 95% confidence interval (CI) 1.09-1.66; P = 0.006. There was no difference in stroke [subdistribution hazard ratio (sHR) 1.04; 95% CI 0.72-1.50, P = 0.848]; however, the risk for aortic valve reoperation was higher (sHR 2.36; 95% CI 1.42-3.94, P = 0.001), and for major bleeding lower (sHR 0.49; 95% CI 0.34-0.70, P < 0.001), in patients who had received bioprostheses than in those with mechanical valves.

CONCLUSION:

Patients aged 50-69 years who received mechanical valves had better long-term survival after AVR than those with bioprostheses. The risk of stroke was similar; however, patients with bioprostheses had a higher risk of aortic valve reoperation and a lower risk of major bleeding.

CLINICAL TRIAL REGISTRATION:

http://clinicaltrials.gov/show/NCT02276950.

CLINICALTRIALSGOV IDENTIFIER:

NCT02276950.

KEYWORDS:

Aortic valve replacement; Bioprosthesis; Cardiac surgery; Mechanical valve; Middle-aged

PMID:
26559386
DOI:
10.1093/eurheartj/ehv580
[Indexed for MEDLINE]

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