title: Survival and long-term outcomes following bioprosthetic vs mechanical aortic valve replacement in patients aged 50 to 69 years.
abstract: OBJECTIVE
  The choice between bioprosthetic and mechanical aortic valve replacement in younger patients is controversial because long-term survival and major morbidity are poorly characterized.
  
  
  OBJECTIVE
  To quantify survival and major morbidity in patients aged 50 to 69 years undergoing aortic valve replacement.
  
  
  METHODS
  Retrospective cohort analysis of 4253 patients aged 50 to 69 years who underwent primary isolated aortic valve replacement using bioprosthetic vs mechanical valves in New York State from 1997 through 2004, identified using the Statewide Planning and Research Cooperative System. Median follow-up time was 10.8 years (range, 0 to 16.9 years); the last follow-up date for mortality was November 30, 2013. Propensity matching yielded 1001 patient pairs.
  
  
  METHODS
  Primary outcome was all-cause mortality; secondary outcomes were stroke, reoperation, and major bleeding.
  
  
  RESULTS
  No differences in survival or stroke rates were observed in patients with bioprosthetic compared with mechanical valves. Actuarial 15-year survival was 60.6% (95% CI, 56.3%-64.9%) in the bioprosthesis group compared with 62.1% (95% CI, 58.2%-66.0%) in the mechanical prosthesis group (hazard ratio, 0.97 [95% CI, 0.83-1.14]). The 15-year cumulative incidence of stroke was 7.7% (95% CI, 5.7%-9.7%) in the bioprosthesis group and 8.6% (95% CI, 6.2%-11.0%) in the mechanical prosthesis group (hazard ratio, 1.04 [95% CI, 0.75-1.43). The 15-year cumulative incidence of reoperation was higher in the bioprosthesis group (12.1% [95% CI, 8.8%-15.4%] vs 6.9% [95% CI, 4.2%-9.6%]; hazard ratio, 0.52 [95% CI, 0.36-0.75]). The 15-year cumulative incidence of major bleeding was higher in the mechanical prosthesis group (13.0% [95% CI, 9.9%-16.1%] vs 6.6% [95% CI, 4.8%-8.4%]; hazard ratio, 1.75 [95% CI, 1.27-2.43]). The 30-day mortality rate was 18.7% after stroke, 9.0% after reoperation, and 13.2% after major bleeding.
  
  
  CONCLUSIONS
  Among propensity-matched patients aged 50 to 69 years who underwent aortic valve replacement with bioprosthetic compared with mechanical valves, there was no significant difference in 15-year survival or stroke. Patients in the bioprosthetic valve group had a greater likelihood of reoperation but a lower likelihood of major bleeding. These findings suggest that bioprosthetic valves may be a reasonable choice in patients aged 50 to 69 years.
authors.affiliation: Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, New York.
authors.forename: Yuting P
authors.initials: YP
authors.lastname: Chiang
authors.affiliation: Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, New York.
authors.forename: Joanna
authors.initials: J
authors.lastname: Chikwe
authors.affiliation: Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Moskowitz
authors.affiliation: Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, New York.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Itagaki
authors.affiliation: Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, New York.
authors.forename: David H
authors.initials: DH
authors.lastname: Adams
authors.affiliation: Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Natalia N
authors.initials: NN
authors.lastname: Egorova
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011474:Prosthesis Design; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D016019:Survival Analysis