Long-term clinical outcomes in patients between the age of 50-70 years receiving biological versus mechanical aortic valve prostheses.

Abstract

Objectives: The last two decades have seen an incremental use of biological over mechanical prostheses. However, while short-term clinical outcomes are largely equivalent, there is still controversy about long-term outcomes.

Methods: All patients between the ages of 50-70 years undergoing elective/urgent isolated aortic valve replacement at our institute between 1996 to 2023 were included. Trends, early and long term outcomes were investigated.

Results: A total of 1708 (61% male) patients with a median age of 63.60 (IQR : 58.28,67.0) years were included of which 1191 (69.7%) received a biological prosthesis.After inverse propensity score weighting, there were no short-term differences when comparing patients receiving biological and mechanical valves. However, patients who received mechanical prostheses had better long-term survival (p < 0.001). Sub-group analysis revealed that patients with biological size 19 mm prosthesis had the worse long-term survival. Patients with a size 21 mm mechanical prosthesis had better survival compared to both size 19 mm (HR: 0.25, 95% CI: 0.17,0.37, p < 0.001), 21 mm (HR: 0.33, 95% CI: 0.23,0.48, p < 0.001) and 23 mm (HR: 0.40, 95% CI: 0.27,0.60, p = <0.001) biological prosthesis.Additionally, patients with severe patient-prosthesis mismatch exhibited the lowest survival rate compared to those with moderate or no (HR 1.56, 95% CI 1.21, 2.00, p < 0.001).

Conclusions: Patients aged between 50-70 years with a mechanical aortic prosthesis had better long-term survival compared to those with a biological prosthesis. Our study underscores the need for a critical re-evaluation of prosthesis selection strategies in this age group.