15 years outcomes following bioprosthetic versus mechanical aortic valve replacement in patients aged 50–65 years with isolated aortic stenosis

Abstract

ObjectivesTo investigate long term survival (15 years) and major morbidity in patients aged 50–65 years undergoing primary isolated aortic valve replacement with bioprosthetic or mechanical valves. MethodsA single center retrospective analytical study of all patients aged 50–65 years with severe aortic stenosis who underwent surgery between 2000 and 2015 was performed (n=200). Two groups, mechanical (n=117) and biological (n=83) were obtained. Propensity score matching was performed for analysis. Primary outcome was survival, secondary outcome was major adverse cardiovascular complications (30-day mortality, stroke, any prosthesis-related reoperation and major bleeding). ResultsMean age was 60±4 years, 33% female, mean follow up was 8.2±3 years (range 0–17 years). Matched overall survival was similar between groups, 65% at 15 years [Log Rank p=0.71, hazard ratio 0.87 (95% CI, 0.41–1.82)]. After matching, mechanical prosthesis presented a trend toward of more major adverse cardiovascular complications (30% versus 15%, p=0.07) with more major bleedings (15% versus 6.3%, p=0.06), stroke 11% versus 7.6% (p=0.44), and cardiac-related rehospitalization (33.7% versus 21.5%, p=0.06). Reoperation was nonsignificant between groups (2.5% mechanical versus 6.3% bioprosthesis, with only 2 cases of structural valve degeneration). Follow up mean transprosthetic gradients were higher in the mechanical group (18±6 versus 15±7mmHg, p=0.01). ConclusionsAmong propensity matched patients there were no differences in survival between groups at 15 years. The mechanical prosthesis presented a trend toward twofold more major adverse cardiovascular complications specially due to major bleeding. Studies with larger sample sizes are needed to confirm these results.