A new study published in JAMA suggests that younger patients who need aortic valve replacement (AVR) may now be more eligible to receive bioprosthetic valves. Each year about 50,000 people in the U.S. undergo AVR surgery. Older patients generally receive bioprosthetic valves because these valves are less prone to clotting and bleeding complications. Surgeons are often reluctant to use bioprosthetic devices in younger patients because these devices are more likely to deteriorate and require a repeat operation.
Researchers at Mt. Sinai Medical Center analyzed data from 4253 patients in New York State who were 50-69 years of age and who received a bioprosthetic or mechanical valve. After adjusting for differences in baseline risk, they compared clinical outcomes associated with the two valves in 1001 matched patient pairs.
There were no differences in mortality or stroke between the two groups. There were more reoperations in the bioprosthesis group, while there were more major bleeding episodes in the mechanical prosthesis group. Here are the cumulative 15-year rates:
- Mortality: 60.6% in the bioprosthesis group versus 62.1% in the mechanical prosthesis group
- Stroke: 7.7% versus 8.6%
- Reoperation: 12.1% versus 6.9%
- Major bleeding: 13% versus 6.6%
"The absence of a significant survival benefit associated with one prosthesis type over another focuses decision making on lifestyle considerations, including the burden of anticoagulation medication and monitoring, and the relative risks of major morbidity—primarily stroke, reoperation, and major bleeding events," wrote the authors.
