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Long-term survival, stroke rates similar between bioprosthetic, mechanical aortic valve replacement
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Bioprosthetic and mechanical aortic valve replacement were associated with similar 15-year rates of all-cause mortality and stroke, according to data published in JAMA.
Researchers evaluated 4,253 patients aged 50 to 69 years who underwent primary isolated aortic valve replacement in New York from 1997 to 2004. All patients received either bioprosthetic (n=1,466) or mechanical valves (n=2,787). Propensity score matching yielded 1,001 patient pairs between the two groups for analysis. All-cause mortality was the primary outcome of the analysis; secondary outcomes included stroke, reoperation and incidences of major bleeding. Median follow-up was 10.8 years (maximum, 16.9 years).
The prevalence of bioprosthetic aortic valve replacement increased significantly during the study period, from 15% in 1997 to 74% in 2012 (P<.001).
During follow-up, 322 patients who received a bioprosthetic valve and 318 who received a mechanical valve died. The researchers calculated that actuarial 15-year survival was 60.6% in the bioprosthetic-valve group compared with 62.1% in the mechanical-valve group (HR=0.97; 95% CI, 0.83-1.14).
Stroke occurred in 68 patients who received a bioprosthetic valve and 71 who received a mechanical valve. The cumulative incidence of stroke at 15 years was also similar between the groups (7.7% bioprosthetic valve vs. 8.6% mechanical valve; HR=1.04; 95% CI, 0.75-1.43). The researchers noted a lower rate of reoperation in the mechanical-valve group compared with the bioprosthetic-valve group (6.9% vs. 12.1%; HR=0.52; 95% CI, 0.36-0.75). Major bleeding was significantly more common among mechanical-valve recipients (13% vs. 6.6%; HR=1.75; 95% CI, 1.27-2.43).
“Current consensus guidelines state that choice of either a bioprosthetic or mechanical prosthetic aortic valve is reasonable in patients aged 60 to 70 years, and that a mechanical valve replacement is reasonable in patients younger than 60 years without contraindications to Coumadin,” the researchers concluded. “Our analysis of a large, contemporary patient cohort supports the view that either prosthesis type is a reasonable choice in patients aged 60 to 69 years, and suggests that this recommendation could reasonably be extended to include patients aged 50 to 59 years.”
Disclosure: See the full study for a list of relevant financial disclosures.
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