title: Comparison between biological and mechanical aortic valve prostheses in middle-aged patients matched through propensity score analysis: long-term results.
abstract: OBJECTIVE
  Choice of prosthesis type in middle-aged patients undergoing aortic valve replacement (AVR) is still debated. The aim of this study is to compare long-term follow-up results in middle-aged patients who underwent isolated AVR with a biological or mechanical prosthesis.
  
  
  METHODS
  A retrospective analysis of a single-centre database was performed to identify patients aged between 55 and 65 years old who underwent isolated AVR with a biological or mechanical prosthesis from January 1996 to January 2008. Sixty patients with a biological aortic valve prosthesis (Group A) were identified and matched through propensity score analysis to other 60 patients with a mechanical aortic valve prosthesis (Group B).
  
  
  RESULTS
  There was no difference among groups regarding postoperative complications. Follow-up amounted to 117 ± 51 months. In Group A and B patients, 10- and 15-year survival was 77 ± 6 vs 75 ± 6 and 54 ± 13 vs 53 ± 8%, respectively (P = 0.95); 10- and 15-year freedom from structural valve deterioration, 81 ± 7 vs 100 and 64 ± 12 vs 93 ± 5%, respectively (P = 0.003); 10- and 15-year freedom from redo AVR, 87 ± 6 vs 91 ± 5 and 73 ± 11 vs 91 ± 5%, respectively (P = 0.04); 10- and 15-year freedom from endocarditis, 94 ± 3 vs 98 ± 2 and 83 ± 8 vs 98 ± 2%, respectively (P = 0.05); 10- and 15-year freedom from bleeding events, 98 ± 2 vs 96 ± 5 and 88 ± 6 vs 77 ± 10%, respectively (P = 0.98); and 10- and 15-year freedom from cerebrovascular events, 94 ± 3 vs 97 ± 3 and 83 ± 8 vs 97 ± 3%, respectively (P = 0.03).
  
  
  CONCLUSIONS
  While survival was not different among groups, patients with a biological prosthesis showed a higher valve-related morbidity at follow-up. Therefore, middle-aged patients should preferably receive a mechanical prosthesis.
authors.affiliation: Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Mazen
authors.initials: M
authors.lastname: Roumieh
authors.affiliation: Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany ius.fabio@mh-hannover.de ius.r@libero.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ius
authors.affiliation: Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Igor
authors.initials: I
authors.lastname: Tudorache
authors.affiliation: Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Issam
authors.initials: I
authors.lastname: Ismail
authors.affiliation: Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Fleissner
authors.affiliation: Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.affiliation: Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Serghei
authors.initials: S
authors.lastname: Cebotari
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000706:statistics & numerical data*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D057216:Propensity Score; D011475:Prosthesis Failure; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Aortic valve prosthesis; Biological; Follow-up; Mechanical