This article is more than 5 years old. Information may no longer be current.
Review supports use of bioprosthetic aortic valves for middle-aged patients
Click Here to Manage Email Alerts
Among middle-aged patients undergoing aortic valve replacement, bioprosthetic and mechanical valves were associated with similar rates of survival, stroke and endocarditis at 15 years, but bioprosthetic valves were associated with higher freedom from thromboembolic events and major bleeding events, researchers reported in The Annals of Thoracic Surgery.
The review focused on 13 studies that compared mechanical vs. bioprosthetic valves in middle-aged patients aged 40 to 70 years undergoing AVR. In this review, most of the studies did not include patients requiring aortic valve reoperation or multiple valve replacement.
The researchers observed no difference in the mechanical valve group compared with the bioprosthetic group in survival at 5 years (pooled OR = 0.81; 95% CI, 0.63-1.04), 10 years (pooled OR = 0.75; 95% CI, 0.44-1.28) and 15 years (pooled OR = 1.1; 95% CI, 0.89-1.36). At 5 years, there was also no difference in thromboembolic events, but at 10 years mechanical valves were associated with higher risk for blood clot than bioprosthetic valves (pooled OR = 0.54; 95% CI, 0.35-0.85) and at 15 years (pooled OR = 0.61; 95% CI, 0.44-0.86) as well.
In addition, mechanical valves were associated with increased risk for a major bleeding event compared with bioprosthetic valves at 5 years (pooled OR = 0.6; 95% CI, 0.41-0.89), 10 years (pooled OR = 0.75; 95% CI, 0.59-0.96) and 15 years (pooled OR = 0.4; 95% CI, 0.19-0.84).
Patients with bioprosthetic valves, however, experienced a higher rate of reoperation than those with mechanical valves at 5 years (pooled OR = 2.88; 95% CI, 1.16-6.9), 10 years (pooled OR = 1.92; 95% CI, 1.05-3.51) and 15 years (pooled OR = 1.95; 95% CI, 1.16-3.3).
“The assumption of reoperation due to valve deterioration requires some caution, however, as not all [bioprosthetic valve] reoperations are due to [structural valve deterioration], and likewise, [mechanical valves] carried a risk of reoperation despite very low rates of [structural valve deterioration]. Unfortunately, no studies reported rates of [structural valve deterioration] specifically,” the researchers wrote.
Because results showed that major bleeding increased mortality risk more than reoperation, the researchers recommended that bioprosthetic valves be strongly considered for middle-aged patients.
“We combined the best available evidence comparing mechanical valves vs. bioprosthetic valves to determine the risks and benefits to patients following surgery, depending on the type of valve they received,” James J. Wu, BMusStudies, from Sydney Medical School at the University of Sydney, the Baird Institute of Applied Heart and Lung Surgical Research, and the cardiothoracic surgery unit at Royal Price Alfred Hospital, said in a press release. “We hope that our results can give future patients needing AVR more information to help them choose the appropriate replacement valve for their condition.”
“This is a complex decision that requires up-to-date evidence. There are options to reduce the bleeding risk of mechanical valves, so ideally, a discussion with both the surgeon and cardiologist is warranted to take into account an individual’s circumstance,” Paul G. Bannon, MBBS, PhD, also from Sydney Medical School at the University of Sydney, the Baird Institute of Applied Heart and Lung Surgical Research, and the cardiothoracic surgery unit at Royal Prince Alfred Hospital, said in the release. – by Tracey Romero
Disclosure: Bannon and Wu report no relevant financial disclosures.
Click Here to Manage Email Alerts