title: Isolated aortic valve replacement with bio-prostheses in patients age 50 to 65 years: a decade of statewide data on cost and patient outcomes.
abstract: BACKGROUND
  Guidelines for choice of replacement valve-mechanical versus bio-prosthetic, are well established for patients aged <50 and >65 years. We studied the trends and implications of aortic valve replacement (AVR) with mechanical versus bioprosthetic valve in patients aged 50 to 65 years.
  
  
  METHODS
  STS and cost database of 17 centers for isolated AVR surgery were analyzed by dividing them into bioprosthetic valve (BV) or mechanical valve (MV) groups.
  
  
  RESULTS
  From 2002 to 2011, 3,690 patients had AVR, 18.6% with MV and 81.4% with BV. Use of BV for all ages increased from 71.5% in 2002 to 87% in 2011. There were 1127 (30.5%) patients in the age group 50-65 years. Use of BV in this group almost doubled, 39.6% in 2002 to 76.8% in 2011. Mean age of patients in BV group was higher (59.2±4.2 years vs. 56.7±4.3 years, P≤0.0001). Preoperative renal failure, heart failure and chronic obstructive pulmonary disease favored use of BV, whereas preoperative atrial fibrillation favored AVR with MV. Mortality (MV 2.2% vs. BV 2.36%) and other postoperative outcomes between the groups were similar. Cost of valve replacement increased for both groups (MV $26,191 in 2002 to $42,592 in 2011; BV $27,404 in 2002 to $44,257 in 2011).
  
  
  CONCLUSIONS
  Use of bioprostheses for AVR has increased; this change is more pronounced in patients aged 50-65 years. Specific preoperative risk factors influence the choice of valve for AVR. Postoperative outcomes between the two groups were similar. Long-term implications of this changing practice, in particular, reoperation for bioprosthetic valve degeneration should be examined.
authors.affiliation: Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA, USA - mquader@mcvh-vcu.edu.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Quader
authors.affiliation: Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Luke
authors.initials: L
authors.lastname: Wolfe
authors.affiliation: Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Angel
authors.initials: A
authors.lastname: Median
authors.affiliation: Aramus Corporation, San Mateo, CA, USA.
authors.forename: Clifford
authors.initials: C
authors.lastname: Fonner
authors.affiliation: Division of Cardiothoracic Surgery, University of Virginia Health Sciences, Charlottesville, VA, USA.
authors.forename: Gorav
authors.initials: G
authors.lastname: Ailawadi
authors.affiliation: Division of Cardiothoracic Surgery, University of Virginia Health Sciences, Charlottesville, VA, USA.
authors.forename: Ivan
authors.initials: I
authors.lastname: Crosby
authors.affiliation: Falls Church, VA, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Speir
authors.affiliation: Mid Atlantic Cardiothoracic Surgery Ltd., Norfolk, VA, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Rich
authors.affiliation: Division of Cardiothoracic Surgery, University of Virginia Health Sciences, Charlottesville, VA, USA.
authors.forename: Damien
authors.initials: D
authors.lastname: Lapar
authors.affiliation: Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Vigneshwar
authors.initials: V
authors.lastname: Kasirajan
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D001705:Bioprosthesis; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome