Age-Based Outcomes after Surgical Aortic Valve Replacement with Bioprosthetic versus Mechanical Valves.

Recommendations for prosthesis type in older patients undergoing surgical aortic valve replacement (SAVR) are established, albeit undervalidated. The purpose of this study is to compare outcomes after bioprosthetic vs mechanical SAVR across various age groups. This was a retrospective study using an institutional SAVR database. All patients who underwent isolated SAVR were compared across valve types and age strata (<65 years, 65-75 years, >75 years). Patients who underwent concomitant operations, aortic root interventions, or prior aortic valve replacement were excluded. Objective survival and aortic valve reinterventions were compared. Kaplan-Meier survival estimation and multivariate regression were performed. A total of 1,847 patients underwent SAVR from 2010-2023. 1,452 (78.6%) patients received bioprosthetic valves while 395 (21.4%) received mechanical valves. Of those who received bioprosthetic valves, 349 (24.0%) were <65 years old, 627 (43.2%) were 65-75 years old, and 476 (32.8%%) were older than 75. For mechanical valve patients, 308 (78.0%) were <65 years, 84 (21.3%) were between 65-75 years, and 3 (0.7%) were >75 years. Median follow-up in the total cohort was 6.2 [2.6-8.9] years. No statistically significant differences were observed in early-term Kaplan-Meier survival estimates between SAVR valve types in all age groups. However, cumulative incidence estimates of aortic valve reintervention were significantly higher in patients under 65 who received bioprosthetic vs mechanical valves, with 5-year reintervention rates of 5.8% and 3.1%, respectively (p=0.002). On competing risk analysis for valve reintervention, bioprosthetic valves were significantly associated with an increased hazard of AV reintervention (HR, 3.35; 95% CI, 1.73-6.49; p<0.001). In conclusion, SAVR with bioprosthetic valves (particularly in patients <65 years) was comparable in survival to mechanical valve SAVR but significantly associated with increased valve reintervention rates.

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Déclaration de conflit d'intérêts

Declaration of competing interest IS receives institutional research support from Abbott, Atricure, Artivion, Edwards Lifesciences, Medtronic, and Terumo Aortic. None of these are related to this manuscript.