Mazen Roumieh1, Fabio Ius2, Igor Tudorache1, Issam Ismail1, Felix Fleissner1, Axel Haverich1, Serghei Cebotari1. 1. Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany. 2. Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany ius.fabio@mh-hannover.de ius.r@libero.it.
Abstract
OBJECTIVES: Choice of prosthesis type in middle-aged patients undergoing aortic valve replacement (AVR) is still debated. The aim of this study is to compare long-term follow-up results in middle-aged patients who underwent isolated AVR with a biological or mechanical prosthesis. METHODS: A retrospective analysis of a single-centre database was performed to identify patients aged between 55 and 65 years old who underwent isolated AVR with a biological or mechanical prosthesis from January 1996 to January 2008. Sixty patients with a biological aortic valve prosthesis (Group A) were identified and matched through propensity score analysis to other 60 patients with a mechanical aortic valve prosthesis (Group B). RESULTS: There was no difference among groups regarding postoperative complications. Follow-up amounted to 117 ± 51 months. In Group A and B patients, 10- and 15-year survival was 77 ± 6 vs 75 ± 6 and 54 ± 13 vs 53 ± 8%, respectively (P = 0.95); 10- and 15-year freedom from structural valve deterioration, 81 ± 7 vs 100 and 64 ± 12 vs 93 ± 5%, respectively (P = 0.003); 10- and 15-year freedom from redo AVR, 87 ± 6 vs 91 ± 5 and 73 ± 11 vs 91 ± 5%, respectively (P = 0.04); 10- and 15-year freedom from endocarditis, 94 ± 3 vs 98 ± 2 and 83 ± 8 vs 98 ± 2%, respectively (P = 0.05); 10- and 15-year freedom from bleeding events, 98 ± 2 vs 96 ± 5 and 88 ± 6 vs 77 ± 10%, respectively (P = 0.98); and 10- and 15-year freedom from cerebrovascular events, 94 ± 3 vs 97 ± 3 and 83 ± 8 vs 97 ± 3%, respectively (P = 0.03). CONCLUSIONS: While survival was not different among groups, patients with a biological prosthesis showed a higher valve-related morbidity at follow-up. Therefore, middle-aged patients should preferably receive a mechanical prosthesis.
OBJECTIVES: Choice of prosthesis type in middle-aged patients undergoing aortic valve replacement (AVR) is still debated. The aim of this study is to compare long-term follow-up results in middle-aged patients who underwent isolated AVR with a biological or mechanical prosthesis. METHODS: A retrospective analysis of a single-centre database was performed to identify patients aged between 55 and 65 years old who underwent isolated AVR with a biological or mechanical prosthesis from January 1996 to January 2008. Sixty patients with a biological aortic valve prosthesis (Group A) were identified and matched through propensity score analysis to other 60 patients with a mechanical aortic valve prosthesis (Group B). RESULTS: There was no difference among groups regarding postoperative complications. Follow-up amounted to 117 ± 51 months. In Group A and B patients, 10- and 15-year survival was 77 ± 6 vs 75 ± 6 and 54 ± 13 vs 53 ± 8%, respectively (P = 0.95); 10- and 15-year freedom from structural valve deterioration, 81 ± 7 vs 100 and 64 ± 12 vs 93 ± 5%, respectively (P = 0.003); 10- and 15-year freedom from redo AVR, 87 ± 6 vs 91 ± 5 and 73 ± 11 vs 91 ± 5%, respectively (P = 0.04); 10- and 15-year freedom from endocarditis, 94 ± 3 vs 98 ± 2 and 83 ± 8 vs 98 ± 2%, respectively (P = 0.05); 10- and 15-year freedom from bleeding events, 98 ± 2 vs 96 ± 5 and 88 ± 6 vs 77 ± 10%, respectively (P = 0.98); and 10- and 15-year freedom from cerebrovascular events, 94 ± 3 vs 97 ± 3 and 83 ± 8 vs 97 ± 3%, respectively (P = 0.03). CONCLUSIONS: While survival was not different among groups, patients with a biological prosthesis showed a higher valve-related morbidity at follow-up. Therefore, middle-aged patients should preferably receive a mechanical prosthesis.