title: Late outcomes comparison of nonelderly patients with stented bioprosthetic and mechanical valves in the aortic position: a propensity-matched analysis.
abstract: OBJECTIVE
  Our study compares late mortality and valve-related morbidities between nonelderly patients (aged <65 years) undergoing stented bioprosthetic or mechanical valve replacement in the aortic position.
  
  
  METHODS
  We identified 1701 consecutive patients aged <65 years who underwent aortic valve replacement between 1992 and 2011. A stented bioprosthetic valve was used in 769 patients (45%) and a mechanical valve was used in 932 patients (55%). A stepwise logistic regression propensity score identified a subset of 361 evenly matched patient-pairs. Late outcomes of death, reoperation, major bleeding, and stroke were assessed.
  
  
  RESULTS
  Follow-up was 99% complete. The mean age in the matched cohort was 53.9 years (bioprosthetic valve) and 53.2 years (mechanical valve) (P=.30). Fifteen additional measurable variables were statistically similar for the matched cohort. Thirty-day mortality was 1.9% (bioprosthetic valve) and 1.4% (mechanical valve) (P=.77). Survival at 5, 10, 15, and 18 years was 89%, 78%, 65%, and 60% for patients with bioprosthetic valves versus 88%, 79%, 75%, and 51% for patients with mechanical valves (P=.75). At 18 years, freedom from reoperation was 95% for patients with mechanical valves and 55% for patients with bioprosthetic valves (P=.002), whereas freedom from a major bleeding event favored patients with bioprosthetic valves (98%) versus mechanical valves (78%; P=.002). There was no difference in stroke between the 2 matched groups.
  
  
  CONCLUSIONS
  In patients aged <65 years, despite an increase in the rate of reoperation with stented bioprosthetic valves and an increase in major bleeding events with mechanical valves, there is no significant difference in mortality at late follow-up.
authors: Division of Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass; Division of Cardiac Surgery, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada.
authors: R Scott
authors: RS
authors: McClure
authors: Division of Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass.
authors: Siobhan
authors: S
authors: McGurk
authors: Division of Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass.
authors: Marisa
authors: M
authors: Cevasco
authors: Division of Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass.
authors: Ann
authors: A
authors: Maloney
authors: Division of Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass.
authors: Igor
authors: I
authors: Gosev
authors: Division of Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass.
authors: Esther M
authors: EM
authors: Wiegerinck
authors: Division of Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass.
authors: Genina
authors: G
authors: Salvio
authors: Division of Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass.
authors: George
authors: G
authors: Tokmaji
authors: Division of Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass.
authors: Wernard
authors: W
authors: Borstlap
authors: Division of Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass.
authors: Foeke
authors: F
authors: Nauta
authors: Division of Cardiac Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass. Electronic address: lcohn@partners.org.
authors: Lawrence H
authors: LH
authors: Cohn
mesh_terms: D000328:Adult; D000367:Age Factors; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D001900:Boston; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome