Aortic Valve Replacement Prosthesis Research Articles

Selection of Prosthesis in Aortic Valve Surgery: Short Review and Trend in our Practice in 10 Years

Introduction: In our country, the predominant condition treated in aortic valve surgery in its early stages was aortic valve disease of rheumatic origin, primarily in patients under the age of 60. In recent decades, due to lifestyle changes, increased average lifespan, and a shift in surgical treatment concepts among the elderly, there has been a noticeable trend towards atherosclerotic aortic valve disease treated surgically. This condition poses challenges in selecting the type of prosthesis for surgical replacement—either bioprosthetic or mechanical. The replacement of the aortic valve, aside from its undeniable benefits for patients, also introduces various complications, such as bleeding related to anticoagulation, thromboembolism, prosthetic endocarditis, and structural degeneration of the prosthesis. These complications vary between the two main groups of prostheses: bioprosthetic and mechanical. In this context, we are confronted with the challenge of selecting the type of prosthesis suitable for each patient. This paper presents current issues regarding selecting aortic valve prostheses, considering factors related to the prosthesis and the patient. We will also discuss the trends in prosthesis usage in our country over the past decade. Materials and Methods: We reviewed the types of mechanical and bioprosthetic valves used over the past ten years at our clinic, the Cardiac Surgery Service of the University Hospital Center "Mother Teresa.” We consulted articles, studies, and guidelines for managing heart valve diseases from European and American cardiology associations. Conclusion: The choice of prosthesis for aortic valve replacement remains a current issue, involving considerations of patient-related and prosthesis-related factors. The decision is based on guidelines recommendations, surgical team judgment, and patient preference, following a detailed explanation of the benefits and risks associated with each type of prosthesis.

Initial Multicenter Experience With a Novel Self-Expanding TAVR System in Patients With Aortic Valve Stenosis.

As transcatheter aortic valve replacement is performed increasingly in younger, low-risk patients, the need for commissural alignment and coronary access has increased. Design elements of the JenaValve Trilogy (JVT) transcatheter heart valve (THV) ensure both. This study sought to evaluate the outcome of patients with aortic stenosis (AS) treated with this novel transfemoral, self-expanding THV. We included 43 consecutive patients with severe AS treated with the JVT system at 5 German sites. The primary endpoint of the study was technical success of the procedure. Procedural outcomes, hemodynamic valve performance, and clinical outcomes at 30days were evaluated according to the Valve Academic Research Consortium-3 criteria. The median age was 81 years (Q1-Q3: 77.0-83.9 years) with a median Society of Thoracic Surgeons Risk Score of 3.1% (Q1-Q3: 2.1%-5.9%). Technical success was achieved in 98% (n=42 of 43). One patient was converted to open surgery. The median aortic gradient was 5.0mmHg (Q1-Q3: 4.0-7.0mmHg), and no patient had moderate or greater paravalvular regurgitation (88% [n=37 of 42] with none or trace paravalvular regurgitation). At 30days, major vascular complications and stroke each occurred in 1 (2.3%) patient, 2 (4.7%) patients had died, and permanent pacemaker implantation was needed in 4.9% (n=2 of 41). Overall, early safety at 30days was achieved in 82% (n=27 of 33) of patients. Treatment of AS patients with this novel transfemoral THV system is safe and effective. The JVT offers an excellent alternative to established transcatheter aortic valve replacement prostheses for patients with AS.

Age-Specific Outcomes of Bioprosthetic vs. Mechanical Aortic Valve Replacement: Balancing Reoperation Risk with Anticoagulation Burden.

The choice of prosthesis for aortic valve replacement (AVR) remains challenging. The risk of anticoagulation complications vs. the risk of aortic valve reintervention should be weighed. This study compared the outcomes of bioprosthetic vs. mechanical AVR in patients older and younger than 50. This retrospective study was conducted from 2009 to 2019 and involved 292 adult patients who underwent isolated AVR. The patients were divided according to their age (above 50 years or 50 years and younger) and the type of valves used in each age group. The outcomes of bioprosthetic valves (Groups 1a (>50 years) and 1b (≤50 years)) were compared with those of mechanical valves (Groups 2a (>50 years) and 2b (≤50 years)) in each age group. The groups had nearly equal rates of preexisting comorbidities except for Group 1b, in which the rate of hypertension was greater (32.6% vs. 14.7%; p = 0.025). This group also had higher rates of old stroke (8.7% vs. 0%, p = 0.011) and higher creatinine clearance (127.62 (108.82-150.23) vs. 110.02 (84.87-144.49) mL/min; p = 0.026) than Group 1b. Patients in Group 1a were significantly older than Group 2a (64 (58-71) vs. 58 (54-67) years; p = 0.002). There was no significant difference in the NYHA class between the groups. The preoperative ejection fraction and other echocardiographic parameters did not differ significantly between the groups. Re-exploration for bleeding was more common in patients older than 50 years who underwent mechanical valve replacement (p = 0.021). There was no difference in other postoperative complications between the groups. The groups had no differences in survival, stroke, or bleeding rates. Aortic valve reintervention was significantly greater in patients ≤ 50 years old with bioprosthetic valves. There were no differences between groups in the changes in left ventricular mass, ejection fraction, or peak aortic valve pressure during the 5-year follow-up. The outcomes of mechanical and bioprosthetic valve replacement were comparable in patients older than 50 years. Using bioprosthetic valves in patients younger than 50 years was associated with a greater rate of valve reintervention, with no beneficial effect on the risk of bleeding or stroke.

Mechanical or biological prosthesis for aortic valve replacement in patients aged 45 to 74 years

ObjectiveThe selection of valve prostheses for patients undergoing surgical aortic valve replacement remains controversial. In this study, we compared the long-term outcomes of patients undergoing aortic valve replacement with biological or mechanical aortic valve prostheses. MethodsWe evaluated late results among 5762 patients aged 45 to 74 years who underwent biological or mechanical aortic valve replacement with or without concomitant coronary artery bypass from 1989 to 2019 at 4 medical centers. The Cox proportional hazards model was used to compare late survival; the age-dependent effect of prosthesis type on long-term survival was evaluated by an interaction term between age and prosthesis type. Incidences of stroke, major bleeding, and reoperation on the aortic valve after the index procedure were compared between prosthesis groups. ResultsOverall, 61% (n = 3508) of patients received a bioprosthesis. The 30-day mortality rate was 1.7% (n = 58) in the bioprosthesis group and 1.5% (n = 34) in the mechanical group (P = .75). During a mean follow-up of 9.0 years, the adjusted risk of mortality was higher in the bioprosthesis group (hazard ratio, 1.30, P < .001). The long-term survival benefit associated with mechanical prosthesis persisted until 70 years of age. Bioprosthesis (vs mechanical prosthesis) was associated with a similar risk of stroke (P = .20), lower risk of major bleeding (P < .001), and higher risk of reoperation (P < .001). ConclusionsCompared with bioprostheses, mechanical aortic valves are associated with a lower adjusted risk of long-term mortality in patients aged 70 years or less. Patients aged less than 70 years undergoing surgical aortic valve replacement should be informed of the potential survival benefit of mechanical valve substitutes.

Perceval sutureless bioprosthesis versus Trifecta sutured bioprosthesis for aortic valve replacement: immediate results of the Perfecta study.

The Perceval sutureless biological prosthesis for aortic valve replacement has been introduced with the rationale for shortening surgical, extracorporeal circulation and aortic cross-clamping times, in order to reduce postoperative complications. To evaluate early hemodynamic performance and immediate outcomes of implantation of the Perceval sutureless bioprosthesis in comparison with the St. Jude Trifecta sutured bioprosthesis for aortic valve replacement (Perfecta study). Between December 2014 and June 2023, 281 patients underwent St. Jude Trifecta implantation (n = 220, mean age: 75.2 ±6.5 years) and Perceval implantation, when indicated (n = 61, mean age: 77.9 ±5.1 years). Concomitant CABG was performed in 73 (33%) and in 27 (44%) patients, respectively. Extracorporeal circulation and cross-clamp times were significantly shorter in Perceval patients in all aortic valve replacements (61 ±23 and 49 ±18 minutes vs. 96 ±36 and 67 ±21 minutes), and in isolated procedures (54 ±10 and 43 ±8 minutes vs. 84 ±28 and 66 ±21 minutes) (p < 0.0001, for all comparisons). Operative mortality was absent and 2.7%, respectively (p = 0.2). Postoperatively, low output cardiac syndrome (0% vs. 4.5%) and total rate of major cardiac and non-cardiac related complications (6.6% vs. 18.6%) were significantly lower in Perceval patients (p = 0.01). Echocardiography at discharge in comparison with preoperatively showed a relevant and similar decrease of mean and peak trans-aortic valve gradients for the Trifecta prosthesis (11.6 ±4.3 vs. 50 ±15.2 mm Hg; 21.6 ±7.3 vs. 78.8 ±24 mm Hg) and for the Perceval prosthesis (12.6 ±4.8 vs. 52 ±12.5 mm Hg; 22.6 ±7.9 vs. 77.8 ±16 mm Hg) (p < 0.00001, for all comparisons). Better global cardiac function was observed in Perceval patients. Concomitant multi-vessel and left main coronary artery disease (p = 0.046; HR = 4.6) and chronic pulmonary disease (p = 0.006; HR = 5.6) were detected as independent predictors of death and postoperative major complications. Early hemodynamic performance appears to be satisfactory with the use of Trifecta sutured and Perceval sutureless bioprostheses. Perceval implantation allows reduction of surgical times, better preservation of myocardial contractile function and, consequently, reduction of the risk of postoperative complications.

Long-term outcomes of aortic valve replacement in dialysis patients - a nationwide retrospective cohort study.

Improved durability of modern biologic prostheses and growing experience with the transcatheter valve-in-valve technique have contributed to a substantial increase in the use of bioprostheses in younger patients. However, discussion of prosthetic valve selection in dialysis patients remains scarce as the guidelines are updated. This study aims to compare long-term outcomes between propensity score-matched cohorts of dialysis patients who underwent primary aortic valve replacement with a mechanical prosthesis or a bioprosthesis. Longitudinal data of dialysis patients who underwent primary aortic valve replacement between 1 January 2001 and 31 December 2018, were retrieved from the National Health Insurance Research Database. A total of 891 eligible patients were identified, of whom 243 ideally matched pairs of patients were analyzed. There was no significant difference in all-cause mortality (hazard ratio 1.11, 95% CI: 0.88-1.40) or the incidence of major adverse prosthesis-related events between the two groups (hazard ratio 1.03, 95% CI: 0.84-1.25). In patients younger than 50 years of age, using a mechanical prosthesis was associated with a significantly longer survival time across 10 years of follow-up than using a bioprosthesis (restricted mean survival time) at 10 years: 7.24 (95% CI: 6.33-8.14) years for mechanical prosthesis versus 5.25 (95% CI: 4.25-6.25) years for bioprosthesis, restricted mean survival time difference 1.99 years, 95% CI: -3.34 to -0.64). A 2-year survival gain in favor of mechanical prostheses was identified in dialysis patients younger than 50 years. The authors suggest mechanical prostheses for aortic valve replacement in these younger patients.

Evaluating Reference Ages for Selecting Prosthesis Types for Heart Valve Replacement in Korea

Although a patient's age may be the only objective figure that can be used as a reference indicator in selecting the type of prosthesis in heart valve surgery, different clinical guidelines use different age criteria. To explore the age-associated survival-hazard functions associated with prosthesis type in aortic valve replacement (AVR) and mitral valve replacement (MVR). This cohort study compared the long-term outcomes associated with mechanical and biologic prostheses in AVR and MVR according to recipient's age using a nationwide administrative data from the Korean National Health Insurance Service. To reduce the potential treatment-selection bias between mechanical and biologic prostheses, the inverse-probability-of-treatment-weighting method was used. Participants included patients who underwent AVR or MVR in Korea between 2003 and 2018. Statistical analysis was performed between March 2022 and March 2023. AVR, MVR, or both AVR and MVR with mechanical or biologic prosthesis. The primary end point was all-cause mortality after receiving prosthetic valves. The secondary end points were the valve-related events, including the incidence of reoperation, systemic thromboembolism, and major bleeding. Of the total of 24 347 patients (mean [SD] age, 62.5 [7.3] years; 11 947 [49.1%] men) included in this study, 11 993 received AVR, 8911 received MVR, and 3470 received both AVR and MVR simultaneously. Following AVR, bioprosthesis was associated with significantly greater risks of mortality than mechanical prosthesis in patients younger than 55 years (adjusted hazard ratio [aHR], 2.18; 95% CI, 1.32-3.63; P = .002) and in those aged 55 to 64 years (aHR, 1.29; 95% CI, 1.02-1.63; P = .04), but the risk of mortality reversed in patients aged 65 years or older (aHR, 0.77; 95% CI, 0.66-0.90; P = .001). For MVR, the risk of mortality was also greater with bioprosthesis in patients aged 55 to 69 years (aHR, 1.22; 95% CI, 1.04-1.44; P = .02), but there was no difference for patients aged 70 years or older (aHR, 1.06; 95% CI, 0.79-1.42; P = .69). The risk of reoperation was consistently higher with bioprosthesis, regardless of valve position, in all age strata (eg, MVR among patients aged 55-69 years: aHR, 7.75; 95% CI, 5.14-11.69; P < .001); however, the risks of thromboembolism and bleeding were higher in patients aged 65 years and older after mechanical AVR (thromboembolism: aHR, 0.55; 95% CI, 0.41-0.73; P < .001; bleeding: aHR, 0.39; 95% CI, 0.25-0.60; P < .001), with no differences after MVR in any age strata. In this nationwide cohort study, the long-term survival benefit associated with mechanical prosthesis vs bioprosthesis persisted until age 65 years in AVR and age 70 years in MVR.

Conventional Prostheses versus Sutureless Perceval for Aortic Valve Replacement: A Meta-Analysis.

Perceval sutureless valves have gained popularity. Whether this implant performs superior to the traditional sutured prosthesis remains unclear. This meta- analysis compared the Perceval implants versus the sutured conventional valves for aortic valve replacement (AVR). This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The following databases were accessed: PubMed, Google Scholar, Web of Science, Scopus, and EMBASE. All clinical investigations comparing Perceval versus the conventional prostheses for AVR were considered. The Perceval group demonstrated higher rate of pacemaker implantation (P <0.00001). Aortic cross-clamp (ACC) time (P <0.00001) and cardiopulmonary bypass (CPB) time (P <0.00001) were shorter in the Perceval group. Similarity was found in mean and peak pressure gradient (P = 0.8 and P = 0.2, respectively), mean aortic valve area (P = 0.3), length of intensive care unit (P = 0.4) and hospital stay (P = 0.2), rate of revision (P = 0.11), hemorrhages (P = 0.05), paravalvular leak (P = 0.3), cerebrovascular complication (P = 0.7), and early mortality (P = 0.06). Given the shorter ACC time and CPB time, Perceval AVR can be an alternative in high-risk patients. The higher rate of pacemaker implantation following Perceval may limit its routine implantation.

Excess Reintervention With Mitroflow Prosthesis for Aortic Valve Replacement: Ten-Year Outcomes of a Randomized Trial

BackgroundCurrent bioprostheses are considered to have improved durability and better hemodynamic performance compared with previous designs, but there are limited comparative data on late outcomes. MethodsFrom 2009 through 2011, 300 adults with severe aortic valve stenosis undergoing aortic valve replacement (AVR) were randomly assigned to receive Edwards Magna, St Jude Epic, or Sorin Mitroflow bioprostheses (n = 100, n = 101, n = 99, respectively). Overall survival was analyzed using Kaplan-Meier and Cox proportional hazards methods, whereas competing risk analysis was used for all time-to-event outcomes. Serial echocardiographic data were fitted with longitudinal models stratified by implant valve size. ResultsDuring median follow-up of 9.8 years (interquartile range, 8.7-10.2), 10-year survival was 50% for the Magna group, 42% for the Epic group, and 41% for the Mitroflow group (P = .415). Cumulative risk of stroke was 9% at 10 years, and rates were comparable for the three groups. Indexed aortic valve area and mean gradients were similar among the three groups receiving 19 mm and 21 mm valves, but in larger (23 mm or more) prostheses, gradients were lower (P < .001) and indexed aortic valve areas were higher in the Magna group (P < .001). The 10-year risk of endocarditis differed by group (P = .033), with higher incidence in the Mitroflow vs the Magna group (7% vs 0%, P = .019). Late risk of reinterventions in the Mitroflow group was 22%, compared with 0% in the Magna group (P < .001) and 5% in the Epic group (P = .008). ConclusionsThe Magna valve had the lowest gradients and largest indexed aortic valve area with larger implant sizes. The Mitroflow bioprosthesis is associated with an increased rate of reintervention and possible increased risk of infection compared with Magna and Epic valves.

Flow dynamics of surgical and transcatheter aortic valves: Past to present

ObjectiveTo perform an in vitro characterization of surgical aortic valves (SAVs) and transcatheter aortic valves (TAVs) to highlight the development of the flow dynamics depending on the type of valve implanted and assess the basic differences in the light of flow turbulence and its effect on blood damage likelihood and hemodynamic parameters that shed light on valve performance. MethodsA Starr–Edwards ball and cage valve of internal diameter 22 mm, a 23-mm Medtronic Hancock II SAV, a 23-mm St Jude Trifecta SAV, a 23-mm St Jude SJM (mechanical valve) SAV, a 26-mm Medtronic Evolut TAV, and a 26-mm Edwards SAPIEN 3 TAV were assessed in a pulse duplicator under physiological conditions. Particle image velocimetry was performed for each valve. Pressure gradient and effective orifice area (EOA) along with velocity flow field, Reynolds shear stress (RSS), and viscous shear stress (VSS) were calculated. ResultsThe SJM mechanical valve exhibited the greatest EOA (1.96 ± 0.02 cm2), showing superiority of efficiency compared with the same-size Trifecta (1.87 ± 0.07 cm2) and Hancock II (1.05 ± 0.01 cm2) (P < .0001). The TAVs show close EOAs (2.10 ± 0.06 cm2 with Evolut and 2.06 ± 0.03 cm2 with SAPIEN 3; P < .0001). The flow characteristics and behavior downstream of the valves differed depending on the valve type, design, and size. The greater the RSS and VSS the more turbulent the downstream flow. Hancock II displays the greatest range of RSS and VSS magnitudes compared with the same-size Trifecta and SJM. The Evolut displays the greatest range of RSS and VSS compared with the SAPIEN 3. ConclusionsThe results of this study shed light on numerous advancements in the design of aortic valve replacement prosthesis and the subsequent hemodynamic variations. Future surgical and transcatheter valve designs should aim at not only concentrating on hemodynamic parameters but also at optimizing downstream flow properties.

POSB104 Cost-Minimization Analysis of Two 3rd-Generation Bovine Pericardial Aortic Valve Prosthesis for Aortic Valve Replacement in Brazil and Mexico

Surgical Aortic Valve Replacement (SAVR) is a relevant therapy for patients who need valve replacement according to Latin American guidelines, especially for those patients with a long-life expectancy. However, bioprothesis are not exempt from structural valve deterioration and reintervention at mid and long-term, which have been demonstrated in recent articles. Moreover, in a scenario with relevant budget restrictions, resource optimization has become more necessary than ever. Hence, we aimed to estimate the costs associated to the perioperative period and reinterventions in the long-term of 2 of the most frequently used pericardial valve prosthesis in Latin America, the Trifecta® (Trif) and the Magna Ease® (ME) aortic valves from payers perspective in Brazil (Private) and Mexico (Public).

POSB9 Short- and Long-Term Performance of Mechanical Versus Biological Prostheses for Aortic Valve Replacement in Patients with Severe Symptomatic Aortic Stenosis over 65 Years

Latest clinical guidelines recommend biological prostheses as a reasonable choice in patients ≥65 years requiring aortic valve replacement (AVR). The aim is to compare clinical outcomes (major adverse events survival at short and long term) and resource-consumption (health resources, anticoagulation rates and post-surgery length of stay in ward -LoS- and intensive care unit -ICU-) between mechanical (MAVI) and biological aortic valve implants (BAVI) in AVR.

Post hoc patient satisfaction with the choice of valve prosthesis for aortic valve replacement: results of a single-centre survey.

Our goal was to examine post hoc patient satisfaction and the decision-making process of choosing a prosthesis for aortic valve replacement (AVR). We surveyed 113 patients who were operated on for AVR at 60-70 years of age, including 74 patients with a mechanical valve (MECH) and 39 with a bioprosthesis (BIO). The study focused on quality of life and the decision pathway in relation to prosthesis choice and valve-related complications. Decisional conflict was defined as the post hoc uncertainty perceived by patients regarding their choice of prosthesis. The survey was performed at a median of 5.2 (3.2-8.1) years after the AVR. Patients with a biological valve were older (BIO: 68.4 years [66.2-69.4] vs MECH: 63.9 [61.9-66.7]; P < 0.001). Global post hoc satisfaction with prosthesis choice was high in both groups (MECH: 95.9%; BIO: 100%), and 85.1% (MECH) and 92.3% (BIO) of them would repeat their choice. Conflict about their decision was equal (MECH: 30.3%; BIO: 32.6%) for different reasons: MECH patients experienced more anticoagulation-related inconvenience (25.9% vs 0%), fear of bleeding (31.1% vs 0%) and prosthesis noise (26.2% vs 0%), whereas more BIO patients feared prosthesis failure (39.7% vs 17.4%) or reoperation (43.5% vs 18.1%). Active involvement in the decision (odds ratio 0.37, 95% confidence interval 0.16-0.85; P = 0.029) and adequate information about the prosthesis (odds ratio 0.34, 95% confidence interval 0.14-0.86; P = 0.020) decreased the risk of conflict about the decision. Although 30% of the responders showed a decisional conflict related to prosthesis-specific interferences, global patient satisfaction with the prosthesis choice for AVR is excellent. Increasing the patient's involvement in the prosthesis choice through shared accountability and improved information is recommended to decrease the choice-related uncertainty.

Propensity matched long-term analysis of mechanical versus stentless aortic valve replacement in the younger patient.

The choice of prosthesis for aortic valve replacement (AVR) in younger patients remains controversial. Stentless AVR was introduced 3 decades ago, with the aim of better haemodynamics and durability than stented xenografts. The objective of this analysis was to compare the long-term outcomes to mechanical prostheses in younger patients (age ≤60 years). All adult patients who underwent AVR due to aortic valve stenosis and/or insufficiency between 1993 and 2002 were identified. After the exclusion of patients with congenital heart defects, aortic dissections and Ross-procedures, 158 patients with stentless valves and 226 patients with bi-leaflet mechanical valves were finally included in this analysis. Sixty-six patient pairs could be included in a propensity matched analysis. Mortality and morbidity including stroke, bleeding, endocarditis and reoperation were analysed. Group baseline characteristics and operative data did not differ significantly after propensity matching. Hospital mortality was 0.0% in the stentless and 1.5% in the mechanical group. Total patient years/median follow-up was 2029.1/15.4 years (completeness: 100.0%, range: 0-25 years). After 20 years, actuarial survival was 47.0 ± 6.4% in the stentless and 53.3 ± 6.6% in mechanical group (P = 0.69). Bleeding, endocarditis and stroke occurred rarely and did not differ significantly between groups. After 20 years, actuarial overall freedom-from-reoperation was 45.1 ± 8.2% in the stentless group and 90.4 ± 4.1% in the mechanical group (P < 0.001). Hospital mortality while reoperation was 7.4% in the stentless group and 0% in the mechanical group (P = 1.0). Long-term morbidity and mortality of stentless and mechanical aortic valves were statistically not different besides a significantly higher reoperation rate after stentless AVR combined with a probably higher risk of in-hospital mortality. Thus, mechanical AVR should remain the procedure of choice in younger patients.

Prosthesis Selection for Aortic Valve Replacement With Concomitant Coronary Artery Bypass Grafting

BackgroundThe optimal prosthesis for aortic valve replacement (AVR) with concomitant coronary artery bypass grafting (CABG) is controversial. We investigated postoperative outcomes in these patients with a biological prosthesis or mechanical prosthesis. MethodsA retrospective cohort analysis was performed of 2485 patients aged 50 to 69 years who underwent AVR+CABG in Hubei province hospitals from 2002 to 2018. The median follow-up duration was 6.5 years (interquartile range, 0-15.8 years). Propensity score matching for 18 baseline characteristics yielded 346 patient pairs between bioprosthetic and mechanical prosthetic groups. End points were death, stroke, major bleeding event, and reoperation. ResultsNo differences in survival, stroke, or overall reoperation rates were observed between the bioprosthetic and mechanical valve groups. The 15-year cumulative incidence of reoperation due to prosthesis failure/dysfunction was higher in the bioprosthetic group (hazard ratio [HR], 2.72; 95% confidence interval [CI], 1.26-5.88; P = .011), whereas the 15-year cumulative incidence of reoperation due to coronary artery disease progression/bypass failure was similar between 2 groups (HR, 0.76; 95% CI, 0.37-1.57; P = .459). Mechanical valves were associated with a higher 15-year cumulative incidence of major bleeding events compared with bioprosthetic valves (HR, 1.92; 95% CI, 1.16-3.19; P = .012). ConclusionsLong-term survival, overall reoperation, or stroke incidence was comparable among the 2 groups, while patients with a mechanical valve showed a greater likelihood of major bleeding events. Regarding the limited durability of bioprosthetic valves, a larger sample size monitored for 15 or more years will be necessary to determine the optimal aortic valve prosthesis for patients aged 50 to 69 years undergoing concurrent AVR and CABG.

Biological versus mechanical prostheses for aortic valve replacement

ObjectivesLong-term real-world outcomes are critical for informing decisions about biological (Bio) or mechanical (Mech) prostheses for aortic valve replacement, particularly in patients aged between 50 and 65 years. The objective was to compare long-term survival and major adverse cardiac and cardiovascular events (ie, stroke, reoperation, and major bleeding) within this population. MethodsThis was a multicenter observational study including all patients aged between 50 and 65 years who underwent an aortic valve replacement because of severe isolated aortic stenosis between the years 2000 and 2018. A total of 5215 patients from 27 Spanish hospitals were registered with a follow-up of 15 years. Multivariable analyses, including a 2:1 propensity score matching (1822 Mech and 911 Bio) and competing risks analyses were applied. ResultsBio prostheses were implanted in 19% of patients (n = 992). No significant differences were observed between matched groups in long-term survival (hazard ratio [HR], 1.14; 95% confidence interval [CI], 0.88-1.47; P = .33). Stroke rates were higher for Mech prostheses, but not significant (HR, 0.72; 95% CI, 0.50-1.03; P = .07). Finally, higher rates of major bleeding were found in the Mech group (HR, 0.65; 95% CI, 0.49-0.87; P = .004), whereas reoperation was more frequent among the Bio group (HR, 3.04; 95% CI, 1.80-5.14; P < .001). Bio prostheses increased from 13% in the period from 2000 to 2008 to 24% in 2009 to 2018. ConclusionsLong-term survival was comparable among groups in patients between 50 and 65 years of age. Mech prostheses were associated with a higher risk of major bleeding, whereas Bio prostheses entailed higher reoperation rates. Bio prostheses seem a reasonable choice for patients between 50 and 65 years in Spain.

Bioprosthetic or mechanical heart valves: prosthesis choice for borderline patients?-Results from 9,616 cases recorded in Polish national cardiac surgery registry.

BackgroundIn middle-aged patients undergoing aortic valve replacement (AVR), the selection of prosthesis type is a complex process. Current guidelines do not unequivocally indicate the type of prosthesis (bioprosthetic or mechanical) recommended for patients between 60–70 years of age. The aim of the study was to present the trends in AVR prosthesis selection in borderline patients over a 10-year period, based on real-life registry data.MethodsThe study population comprised of 9,616 consecutive patients aged between 60–70 years, who underwent isolated AVR between 2006 and 2016 in all cardiac surgery departments in Poland. Data were extracted from the Polish National Registry of Cardiac Surgery.ResultsAmong 27,797 consecutive AVR procedures, patients aged 60–70 years represented 34.6% of the population operated on. From 2006 to 2016, bioprosthetic valves (BVs) were implanted in 53.9% cases, (and) mechanical valves (MVs) in 42.1%. The proportion of different valve types changed in time: from 77.5% of MVs vs. 22.5% of BVs in 2006 to 23.2% of MVs vs. 76.8% of BVs in 2016 (P<0.001). The most commonly implanted BV was the Hancock II (used in 36.4% of BV implantations), the most commonly used MV was the Saint Jude Mechanical prosthesis (implanted in 36.4% of MV implantation cases). A multivariable model identified smaller annulus [OR (95% CI) 0.89 (0.86–0.92), P<0.001], atrial fibrillation [OR (95% CI) 1.32 (1.05–1.67), P=0.017], male sex [OR (95% CI) 1.47 (1.24–1.74), P<0.001] and year of implantation [OR (95% CI) 0.75 (0.71–0.79), P<0.001] as predictors of MV implantation.ConclusionsPatients aged 60–70 years represent more than one-third of all AVR patients. Between 2006 and 2016, the proportion of implanted prostheses has changed dramatically. In 2016 BVs were implanted in nearly 75% of AVR cases, three times more often than in 2006.

AN 18-YEAR WORLD, EVIDENCE-BASED ANALYSIS COMPARING BIOLOGICAL AND MECHANICAL PROSTHESES FOR ISOLATED AORTIC VALVE REPLACEMENT IN PATIENTS AGED 50 TO 65 YEARS: THE SPANISH AORTIC VALVE MULTICENTRIC STUDY (SPAVALVE)

Long-term real-world outcomes are critical to support medical decisions about using biological (B) or mechanical (M) prostheses for aortic valve replacement (AVR), particularly in patients aged between 50 and 65 years. This study aims to provide new evidence from a large national database on long-

Implantation of small-diameter mechanical prostheses in aortic valve replacement

Implantation of small-diameter mechanical prostheses in aortic valve replacement

Mitroflow and Perimount Magna 10 years outcomes a direct propensity match analysis to assess reintervention rates and long follow‐up mortality

Biological valves are the most commonly used prostheses for aortic valve replacement (AVR) surgery in the UK. The aim of this retrospective observational study was to compare 10-year outcomes of Perimount Magna and Mitroflow bioprosthesis implanted in a single center. The medical records of patients undergoing AVR in Liverpool Heart and Chest Hospital between 1999 and 2014 were examined. All data were collected retrospectively, and a propensity match analysis was performed with a ratio 3:1 to analyze 10-year outcomes. The primary outcomes were all-cause mortality rates and aortic valve reintervention rates. A total of 2608 patients were included; Mitroflow bioprosthesis was used in 352 patients while Perimount Magna was used in 2256 patients. Median (interquartile range [IQR]) follow-up for the entire data set was 6.95 (4.99, 9.69) years. After 10 years, the all-cause mortality rate was higher in Mitroflow cohort 34.8% vs 14.7% (P < .001). A higher rate of aortic valve reintervention was observed in the Mitroflow cohort (4.7% vs 1%, P < .001). There were significant differences in survival and reintervention-free survival rate between the two groups considered. The implant of the Perimount Magna valve seems to have a better short-term and long-term outcome over Mitroflow valve. Such results require larger studies to be validated.