15 Years Outcomes Following Bioprosthetic Versus Mechanical Aortic Valve Replacement In Patients Aged 50 To 65 Years With Isolated Aortic Stenosis
Emiliano A. Rodríguez-Caulo, Juan Otero-Forero, María-José Mataró, Gemma Sánchez-Espin, Arantza Guzón, Carlos Porras, José M. Villaescusa, Miguel Such, José-María Melero-Tejedor.
Hospital Universitario Virgen de la Victoria de Málaga, Málaga, Spain.
BACKGROUND: There is conflicting evidence regarding long term survival (15 years) and major morbidity in patients aged 50 to 65 years undergoing primary isolated aortic valve replacement with bioprosthetic or mechanical valves. We want to analyze which type of prosthesis would be better. METHODS: A single center retrospective analytical study of all patients aged 50-65 years with severe aortic stenosis who underwent surgery between 2000-2015 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). RESULTS: Mean 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 (CI 95% 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% vs 6,3% p=0.06), stroke 11 vs 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 vs 15±7 mmHg, p=0.01). CONCLUSIONS: Among propensity matched patients there were no differences in survival between groups at 15 years. The mechanical prosthesis presented a trend towards two-fold more major adverse cardiovascular complications specially due to major bleeding. Studies with larger sample sizes are needed to confirm these results and decrease the age for bioprosthesis indication up to above 50 years.
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