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

• Published in: Cirugía cardiovascular 2018-05, Vol.25 (3), p.135-140
• Main Authors: Rodríguez-Caulo, Emiliano A., Otero-Forero, Juan J., Sánchez-Espín, Gemma, Mataró, María J., Guzón, Arantza, Porras, Carlos, Villaescusa, José, Such, Miguel, Melero, José M.
• Format: Article
• Language: English
• Subjects: Aortic valve replacement; Bioprosthesis; Bioprótesis; Long-term survival; Mechanical prosthesis; Propensity score; Puntuación de propensión; Supervivencia a largo plazo; Sustitución valvular aórtica; Válvulas mecánicas
• ISSN: 1134-0096
• DOI: 10.1016/j.circv.2018.03.002

To 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. A 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). 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 (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). Among 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. Investigar la supervivencia a largo plazo (15 años) y la morbilidad en pacientes de 50 a 65 años sometidos a reemplazo valvular aórtico aislado con válvulas bioprotésicas o mecánicas. Estudio analítico retrospectivo unicéntrico, de pacientes de 50-65 años con estenosis aórtica severa que se sometieron a cirugía entre 2000-2015 (n=200). Se obtuvieron 2 grupos, mecánico (n=117) y biológico (n=83). Se realiza puntuación de propensión para el análisis final. El objetivo primario fue la supervivencia a largo plazo y como objetivos secundarios las complicaciones cardiovasculares mayores (mortalidad a 30 días, ictus, reintervención protésica y hemorragia grave). La edad media fue 60±4 años, un 33% mujeres. El seguimiento medio fue de 8,2±3 años. La supervivencia g