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J Thorac Cardiovasc Surg. 2019 Dec;158(6):1529-1538.e2. doi: 10.1016/j.jtcvs.2019.02.076. Epub 2019 Mar 1.

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

Author information

1
Section of Cardiac Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Electronic address: alexander.iribarne@hitchcock.org.
2
Department of Cardiothoracic Surgery, Heart and Vascular, University of Vermont Medical Center, Burlington, Vt.
3
Maine Medical Partners, Maine Medical Center, Portland, Maine.
4
Center for Cardiac Care, Concord Hospital, Concord, NH.
5
Department of Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
6
New England Heart and Vascular Institute, Catholic Medical Center, Manchester, NH.
7
Section of Cardiac Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
8
Central Maine Heart and Vascular Institute, Central Maine Medical Center, Lewiston, Maine.
9
EMMC Heart Care, Eastern Maine Medical Center, Bangor, Maine.

Abstract

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.

KEYWORDS:

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

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