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Eur J Cardiothorac Surg 2006;30:485-491
© 2006 Elsevier Science NL

Mechanical versus bioprosthetic valve replacement in middle-aged patients

^a Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin Street, Suite 3403, Ottawa, Ont. K1Y 4W7, Canada
^b Department of Epidemiology, University of Ottawa, Ottawa, Canada

Received 8 February 2006; received in revised form 29 May 2006; accepted 8 June 2006.

^_* Corresponding author. Address: Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin Street, Suite 3403, Ottawa, Ont. K1Y 4W7, Canada. Tel.: +1 613 761 4893; fax: +1 613 761 4713. (Email: mruel{at}ottawaheart.ca).

Objective: The current trend towards decreasing the age for selection of a tissue over a mechanical prosthesis has led to a dilemma for patients aged 50–65 years. This cohort study examines the long-term outcomes of mechanical versus bioprosthetic valves in middle-aged patients. Methods: Patients (N = 659) aged between 50 and 65 years who had first-time aortic valve replacement (AVR) and/or mitral valve replacement (MVR) with contemporary prostheses were followed prospectively after surgery. The total follow-up was 3402 patient-years (mean 5.1 ± 4.1 years; maximum 18.3 years). Outcomes were examined with multivariate actuarial methods. A composite outcome of major adverse prosthesis-related events (MAPE) was defined as the occurrence of reoperation, endocarditis, major bleeding, or thromboembolism. Results: Ten-year survival was 73.2 ± 4.2% after mechanical AVR, 75.1 ± 12.6% after bioprosthetic AVR, 74.1 ± 4.6% after mechanical MVR, and 77.9 ± 7.4% after bioprosthetic MVR (P = NS). Ten-year reoperation rates were 35.4% and 21.3% with aortic and mitral bioprostheses, respectively. Major bleeding occurred more often following mechanical MVR (hazard ratio [HR]: 3.3; 95% confidence interval [CI] 1.2, 9.0; P = 0.022), and the incidence of any thromboembolic event was more common after mechanical MVR (HR: 4.7; CI 1.4, 13.3; P = 0.01). Overall freedom from MAPE at 10 years was 70.2 ± 4.1% for mechanical AVR patients, 41.0 ± 30.3% for bioprosthetic AVR patients, 53.3 ± 8.8% for mechanical MVR patients, and 61.2 ± 9.2% for bioprosthetic MVR patients. Although a trend existed towards more MAPE amongst middle-age patients with tissue valves, multivariate analysis did not identify the presence of a bioprosthesis as an independent risk factor for MAPE (HR: 1.3; CI 0.9, 2.0; P = 0.22). Conclusions: In middle-aged patients, MAPE may occur more often in patients with bioprosthetic valves, but definitive conclusions necessitate the accumulation of additional follow-up. At present, these data do not support lowering the usual cutoff for implantation of a tissue valve below the age of 65.

Key Words: Aortic valve replacement • Mitral valve replacement • Heart valve • Bioprosthesis • Heart valve • Mechanical • Outcomes (includes mortality • morbidity)

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