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. 2024 Jan 2;65(1):ezad308.
doi: 10.1093/ejcts/ezad308.

Revisiting aortic valve prosthesis choice in patients younger than 50 years: 10 years results of the AUTHEARTVISIT study

Denise Traxler  1   2   3 , Pavla Krotka  4 , Berthold Reichardt  5 , Dragan Copic  1   2   6 , Cecilia Veraar  2   7 , Michael Mildner  8 , Ralph Wendt  9 , Johann Auer  10 , Julia Mascherbauer  11 , Hendrik Jan Ankersmit  1   2 , Alexandra Graf  4
Affiliations

Revisiting aortic valve prosthesis choice in patients younger than 50 years: 10 years results of the AUTHEARTVISIT study

Denise Traxler et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: This population-based cohort study investigated mid-term outcome after surgical aortic valve replacement with a bioprosthetic or mechanical valve prosthesis in patients aged <50 years in a European social welfare state.

Methods: We analysed patient data from the main social insurance carriers in Austria (2010-2020). Subsequent patient-level record linkage with national health data provided patient characteristics and clinical outcome. Survival, reoperation, myocardial infarction, heart failure, embolic stroke or intracerebral haemorrhage, bleeding other than intracerebral haemorrhage and major adverse cardiac events were evaluated as outcomes.

Results: A total of 991 patients were analysed. Regarding demographics, no major differences between groups were observed. Multivariable Cox regression revealed no significant difference in overall survival (P = 0.352) with a median follow-up time of 6.2 years. Reoperation-free survival was decreased (hazard ratio = 1.560 [95% CI: 1.076-2.262], P = 0.019) and the risk for reoperation was increased (hazard ratio = 2.770 [95% CI: 1.402-5.472], P = 0.003) in patients who received bioprostheses. Estimated probability of death after reoperation was 0.23 (CL: 0.08-0.35) after 2 years and 0.34 (CL: 0.06-0.53) after 10 years over both groups. Regarding further outcomes, no significant differences between the two groups were observed.

Conclusions: In patients below 50 years of age receiving aortic valve replacement, implantation of bioprostheses when compared to mechanical heart valve prostheses was associated with a significantly higher rate of reoperations and reduced reoperation-free survival. Nevertheless, we could not observe a difference in overall survival. However, long-term follow-up has to evaluate that a significantly lower rate of reoperations may translate in consistently improved long-term survival.

Keywords: Aortic valve replacement; Bioprosthesis; Mechanical aortic valve prosthesis.

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Figures

Figure 1:
Figure 1:
Distribution of Heart Valve Types within the study period. Percentages per year (displayed on the y-axis) and absolute numbers (shown above the bars) of patients receiving mechanical aortic valve or bioprosthetic valve replacement per calendar year.
Figure 2:
Figure 2:
Kaplan–Meier curves for overall survival (A), reoperation-free survival (B) and survival after reoperation (D) as well as cumulative incidence curves for reoperation with competing event death (C).
Figure 3:
Figure 3:
Number at risk, cumulative number of events and event probability with 95% confidence interval for outcome death or reoperation as the first event per group. AVR: aortic valve replacement.
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