title: Very long-term survival implications of heart valve replacement with tissue versus mechanical prostheses in adults <60 years of age.
abstract: BACKGROUND
  Several centers favor replacing a diseased native heart valve with a tissue rather than a mechanical prosthesis, even in younger adult patients. However, long-term data supporting this approach are lacking. We examined the survival implications of selecting a tissue versus a mechanical prosthesis at initial left-heart valve replacement in a cohort of adults <60 years of age who were followed for over 20 years.
  
  
  RESULTS
  Comorbid and procedural data were available from 6554 patients who underwent valve replacement at our institution over the last 35 years. Of these, 1512 patients contributed follow-up data beyond 20 years, of whom 567 were adults <60 years of age at first left-heart valve operation (mean survivor follow-up, 24.0+/-3.1 years). Late outcomes were examined with Cox regression. Valve reoperation, often for prostheses that are no longer commercially available, occurred in 89% and 84% of patients by 20 years after tissue aortic and mitral valve replacement, respectively, and was associated with a mortality of 4.3%. There was no survival difference between patients implanted with a tissue versus a mechanical prosthesis at initial aortic valve replacement (hazard ratio 0.95; 95% CI: 0.7, 1.3; P=0.7). For mitral valve replacement patients, long-term survival was poorer than after aortic valve replacement (hazard ratio 1.4; 95% CI: 1.1, 1.8; P=0.003), but again no detrimental effect was associated with use of a tissue versus a mechanical prosthesis (hazard ratio 0.9; 95% CI 0.5, 1.4; P=0.5).
  
  
  CONCLUSIONS
  In our experience, selecting a tissue prosthesis at initial operation in younger adults does not negatively impact survival into the third decade of follow-up, despite the risk of reoperation.
authors.affiliation: Division of Cardiac Surgery, and the Department of Epidemiology, University of Ottawa, Ottawa, Ontario, Canada. mruel@ottawaheart.ca
authors.forename: Marc
authors.initials: M
authors.lastname: Ruel
authors.forename: Vincent
authors.initials: V
authors.lastname: Chan
authors.forename: Pierre
authors.initials: P
authors.lastname: Bédard
authors.forename: Alexander
authors.initials: A
authors.lastname: Kulik
authors.forename: Ladislaus
authors.initials: L
authors.lastname: Ressler
authors.forename: B Khanh
authors.initials: BK
authors.lastname: Lam
authors.forename: Fraser D
authors.initials: FD
authors.lastname: Rubens
authors.forename: William
authors.initials: W
authors.lastname: Goldstein
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Hendry
authors.forename: Roy G
authors.initials: RG
authors.lastname: Masters
authors.forename: Thierry G
authors.initials: TG
authors.lastname: Mesana
mesh_terms: D000328:Adult; D001705:Bioprosthesis / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000639:trends*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate / Q000639:trends; D013995:Time