Title: Mechanical versus Bioprosthetic Aortic Valves in Middle-Aged Patients: Long-Term Outcomes
Abstract: Objective: Aortic valve disease is the most common pathology of valvular heart surgery. The current treatment of choice for aortic valve stenosis remains conventional surgical aortic valve replacement. However, choice of mechanical or bioprosthetic valve is still controversial for middle-aged patients. Our aim was to evaluate the long-term outcome of mechanical versus bioprosthetic aortic valve replacement in patients aged 50 to 70 years undergoing isolated aortic valve replacement. Methods: We performed a retrospective analysis of patients aged 50 to 70 years who underwent primary isolated aortic valve replacement between 2006 and 2008 in the Heart Center of University of Cologne in Germany. Our primary outcome was 10-year-mortality; our secondary outcomes were stroke, reoperation and cerebral bleeding. Results: Of all 122 included patients, crude 10-year mortality rate was higher for patients undergoing bioprosthetic compared to mechanical valve replacement (49.2 vs. 28.6%; p=0.02). For bioprosthetic vs. mechanical valve replacement, 10-year incidence of stroke (12.7 vs. 11.5%; p=0.836), risk for major bleeding (3.6 vs. 8.2%; p=0.303) and reoperation (1.8 vs. 3.3%; p=0.612) were comparable for both groups. Conclusions: Patients aged 50 to 70 years who undergo primary isolated aortic valve replacement with mechanical compared to bioprosthetic valves show favourable 10-year survival for mechanical valves in our patient cohort. But, there were no statistically significant differences concerning incidence of stroke, risk of reoperation and risk of major bleeding.