Tissue versus mechanical aortic valve replacement in younger patients: A multicenter analysis

J Thorac Cardiovasc Surg. 2019 Dec;158(6):1529-1538.e2. doi: 10.1016/j.jtcvs.2019.02.076. Epub 2019 Mar 1.


Objective: The goal of this study was to examine the long-term survival of patients between the ages of 50 and 65 years who underwent tissue versus mechanical aortic valve replacement (AVR) in a multicenter cohort.

Methods: A multicenter, retrospective analysis of all AVR patients (n = 9388) from 1991 to 2015 among 7 medical centers reporting to a prospectively maintained clinical registry was conducted. Inclusion criteria were: patients aged 50 to 65 years who underwent isolated AVR. Baseline comorbidities were balanced using inverse probability weighting for a study cohort of 1449 AVRs: 840 tissue and 609 mechanical. The primary end point of the analysis was all-cause mortality. Secondary end points included in-hospital morbidity, 30-day mortality, length of stay, and risk of reoperation.

Results: During the study period, there was a significant shift from mechanical to tissue valves (P < .001). There was no significant difference in major in-hospital morbidity, mortality, or length of hospitalization. Also, there was no significant difference in adjusted 15-year survival between mechanical versus tissue valves (hazard ratio, 0.87; 95% confidence interval [CI], 0.67-1.13; P = .29), although tissue valves were associated with a higher risk of reoperation with a cumulative incidence of 19.1% (95% CI, 14.4%-24.3%) versus 3.0% (95% CI, 1.7%-4.9%) for mechanical valves. The reoperative 30-day mortality rate was 2.4% (n = 2) for the series.

Conclusions: Among patients 50 to 65 years old who underwent AVR, there was no difference in adjusted long-term survival according to prosthesis type, but tissue valves were associated with a higher risk of reoperation.

Keywords: bioprosthesis adverse effects; heart valve diseases; heart valve prosthesis adverse effects; mortality; survival analysis.

Publication types

  • Comparative Study
  • Multicenter Study
  • Webcast

MeSH terms

  • Age Factors
  • Aged
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / physiopathology
  • Aortic Valve / surgery*
  • Bioprosthesis*
  • Female
  • Heart Valve Diseases / diagnostic imaging
  • Heart Valve Diseases / mortality
  • Heart Valve Diseases / physiopathology
  • Heart Valve Diseases / surgery*
  • Heart Valve Prosthesis Implantation / adverse effects
  • Heart Valve Prosthesis Implantation / instrumentation*
  • Heart Valve Prosthesis Implantation / mortality
  • Heart Valve Prosthesis*
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Postoperative Complications / mortality
  • Postoperative Complications / surgery
  • Prosthesis Design
  • Recovery of Function
  • Registries
  • Reoperation
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • United States