title: Aortic valve replacement with mechanical vs. biological prostheses in patients aged 50-69 years.
abstract: The objective was to investigate the long-term all-cause mortality in patients aged 50-69 years after aortic valve replacement (AVR) with bioprosthetic or mechanical valves.
  
  
  
  All patients aged 50-69 years who had undergone AVR in Sweden 1997-2013 were identified from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies register. Subsequent patient-level record linkage with national health-data registers provided patient characteristics, vital status, and clinical outcomes. Of the 4545 patients, 60% (2713/4545) had received mechanical valves and 40% (1832/4545) bioprostheses. In 1099 propensity score-matched patient pairs, 16% (180/1099) had died in the mechanical valve group and 20% (217/1099) in the bioprosthetic group; mean follow-up 6.6 (maximum 17.2) years. Survival was higher in the mechanical than in the bioprosthetic group: 5-, 10-, and 15-year survival 92, 79, and 59% vs. 89, 75, and 50%; hazard ratio 1.34; 95% confidence interval (CI) 1.09-1.66; P = 0.006. There was no difference in stroke [subdistribution hazard ratio (sHR) 1.04; 95% CI 0.72-1.50, P = 0.848]; however, the risk for aortic valve reoperation was higher (sHR 2.36; 95% CI 1.42-3.94, P = 0.001), and for major bleeding lower (sHR 0.49; 95% CI 0.34-0.70, P < 0.001), in patients who had received bioprostheses than in those with mechanical valves.
  
  
  
  Patients aged 50-69 years who received mechanical valves had better long-term survival after AVR than those with bioprostheses. The risk of stroke was similar; however, patients with bioprostheses had a higher risk of aortic valve reoperation and a lower risk of major bleeding.
  
  
  
  http://clinicaltrials.gov/show/NCT02276950.
  
  
  
  NCT02276950.
authors.affiliation: Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm SE-171 76, Sweden Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Natalie
authors.initials: N
authors.lastname: Glaser
authors.affiliation: Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm SE-171 76, Sweden Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Veronica
authors.initials: V
authors.lastname: Jackson
authors.affiliation: Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Holzmann
authors.affiliation: Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm SE-171 76, Sweden Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Franco-Cereceda
authors.affiliation: Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm SE-171 76, Sweden Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden Ulrik.Sartipy@karolinska.se.
authors.forename: Ulrik
authors.initials: U
authors.lastname: Sartipy
mesh_terms: D000368:Aged; D001021:Aortic Valve; D001705:Bioprosthesis; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008875:Middle Aged; D012086:Reoperation; D013548:Sweden
keywords: Aortic valve replacement; Bioprosthesis; Cardiac surgery; Mechanical valve; Middle-aged