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Revisiting Prosthesis Choice in Patients Younger than 50 Years: 10 Years Results of the Autheartvisit Study
19 Pages Posted: 10 Jan 2023
More...Abstract
Background: This population-based cohort study investigated mid-term outcome after surgical aortic valve replacement (AVR) with a bioprosthetic or mechanical valve prosthesis in patients aged <50 years in a European social welfare state.
Methods: We analyzed patient data from the three largest public health insurances in Austria (2010–2020). Subsequent patient-level record linkage with national health data provided patient characteristics and clinical outcome. Survival, reoperation, myocardial infarction, heart failure, stroke, and major adverse cardiac events were evaluated as outcomes.
Findings: A total of 991 patients were analyzed. Regarding demographics, no major differences between groups were observed. Multivariable Cox regression revealed no significant difference in overall survival (p=0.239). Reoperation-free survival was decreased (HR=1.592 [1.099–2.307], p=0.014) and the risk for reoperation was increased (HR=2.768 [1.418–5.405], p=0.003) in patients who received bioprostheses. Mortality rate after reoperation was 0.23 [CL: 0.08–0.35] after two years and 0.34 [CL: 0.06–0.53] after ten years over both groups. Regarding further secondary outcomes, no significant differences between the two groups were observed.
Summary: In patients below 50 years of age receiving AVR, implantation of bioprostheses when compared to mechanical heart valve prostheses was associated with a higher significantly rate of reoperations and reduced reoperation-free survival. We could observe a strong albeit not statistically significant trend towards improved overall survival associated with the selection of mechanical heart valves in this young patient population. However, long-term follow up has to evaluate that a significantly lower rate of reoperations will translate in consistently improved long-term survival.FundingInstitutional research laboratories ARGE Ankersmit (FOLAB Chirurgie).
Trial Registration Details: This trial was registered with clincialtrials.gov (NCT05627973).
Funding Information: Institutional research laboratories ARGE Ankersmit (FOLAB Chirurgie).
Declaration of Interests: None.
Ethics Approval Statement: This study was a national population-based cohort study. It complies with the Declaration of Helsinki and was approved by the ethics committee of lower Austria (GS1-EK-4/722- 2021).
Keywords: aortic valve replacement, surgical aortic valve replacement, bioprostheses, mechanical valves, survival, MACE, reoperation
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