Invited Commentary

Abstract

The relative performance of mechanical vs biological aortic valve prostheses in younger patients remains controversial. In this issue of The Annals of Thoracic Surgery, Kytö and colleagues1 should be commended for providing another carefully performed analysis of high quality data representing a large, real-world population. Rather than definitively ending the debate, however, this study underscores the state of equipoise surrounding this question. Multiple prior studies using extremely similar methodologies have reported conflicting results: Chiang and associates2 (using statewide data from New York) demonstrated no difference in survival in patients aged 50-69 years; Goldstone and coworkers3 (using statewide data from California) demonstrated higher mortality in bioprosthetic recipients aged 45-54 years but not in recipients aged 55-64 years; Brown and associates4 (using single-center data from the Mayo Clinic) demonstrated higher mortality in bioprosthetic recipients aged 50-70 years; and Brennan and colleagues5 (using The Society of Thoracic Surgeons National Database) reported higher mortality in bioprosthetic recipients aged 65-69 years but not in those aged 70-80 years.