Surgical Aortic Valve Replacement In Patients Aged 50-69 Years - Insights From The German Aortic Valve Registry (gary)
Ferdinand A. Vogt1, Giuseppe Santarpino2, Buntaro Fujita3, Christian Frerker4, Timm Bauer5, Andreas Beckmann6, Raffi Bekeredjian7, Sabine Bleiziffer8, Helge Möllmann9, Thomas Walther10, Friedhelm Beyersdorf11, Christian Hamm12, Andreas Boening13, Stephan Baldus14, Stephan Ensminger3, Theodor Fischlein1, Dennis Eckner15.
1Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany, 2Paracelsus Medical University Nuremberg, Nürnberg, Germany, 3Department of Thoracic and Cardiovascular Surgery, University Hospital, Lübeck, Lübeck, Germany, 4Department of Cardiology, University Hospital, Heart Center, Lübeck, Lübeck, Germany, 5Department of Cardiology, Sana Klinikum Offenbach, Offenbach, Germany, 6German Society of Thoracic, Cardiac and Vascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, DGTHG), Berlin, Berlin, Germany, 7Department of Cardiology, University of Heidelberg, Heidelberg, Germany, 8Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Bad Oeyenhausen, Germany, 9Department of Internal Medicine I, St.-Johannes-Hospital, Dortmund, Dortmund, Germany, 10Department of Cardiac, Thoracic and Thoracic Vascular Surgery, University Hospital Frankfurt, Frankfurt, Germany, 11Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany, 12Kerckhoff Heart and Thorax Center, Bad Nauheim, Kerckhoff Campus of Justus-Liebig University, Giessen, Giessen, Germany, 13Department of Cardiothoracic Surgery, University Hospital Giessen, Giessen, Germany, 14Department of Internal Medicine III, University Hospital of Cologne, Cologne, Germany, 15Department of Cardiology, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
Objective: The aim of this study was to analyze the outcome of patients between 50 and 69 years of age undergoing biological or mechanical aortic valve replacement. Methods: Data were collected from the German Aortic Valve Registry (GARY). 3046 patients undergoing isolated SAVR between 2011 and 2012 were investigated and a propensity score matching was performed. Data were analyzed regarding baseline characteristics and outcome parameters such as 5-year survival, stroke and reintervention. Results: Within this period 2239 patients received a biological prostheses (bio-SAVR), while 807 patients received a mechanical prothesis (mech-SAVR). Mean age in the bio-SAVR group was 64 (60-67) and 57 (53-61) in the mech-SAVR group (p<0.001). In the overall cohort, there were more female patients in the bio-SAVR group (32.7% vs. 28.4%, p=0.02) and log EuroSCORE was higher (3.2% vs. 2.3%, p<0.001). After propensity matching (545 pairs) there was no difference in the mortality at 5-year follow up (FU) (8.3% bio-SAVR vs. 7.2% mech-SAVR p=0.45) nor for reoperation/reintervention (4.6 % bio-SAVR vs. 2.9% mech-SAVR, p=0.22). Patients undergoing mech-AVR suffered from a higher stroke rate (1.5 vs. 0.4 % (p=0.06) at discharge; 2.4 vs 0.7 % at 1-year-FU; 4.5 vs. 1.0 % 3-year-FU and 5.3 vs. 2.4 % at 5-year-FU). Conclusion: AVR with biological or mechanical prostheses showed similar five-year-outcomes for survival and reoperation in a propensity matched cohort. Regarding the increased stroke rate after mechanical AVR after a follow-up period of five years, the choice of a mechanical valve in younger patients should be made more carefully.
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