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. 2025 Jan 26;12(2):44.
doi: 10.3390/jcdd12020044.

Bioprostheses and Mechanical Prostheses for Aortic Valve Replacement in Patients Aged 50 to 65 Years Offer Similar Long-Term Survival Rates

Tomáš Toporcer  1 , Štefan Lukačín  1 , Andrea Kraus  2 , Marián Homola  1 , Anton Bereš  1 , Michal Trebišovský  1 , Denis Radótzy  1 , Vilém Rohn  3 , Adrián Kolesár  1
Affiliations

Bioprostheses and Mechanical Prostheses for Aortic Valve Replacement in Patients Aged 50 to 65 Years Offer Similar Long-Term Survival Rates

Tomáš Toporcer et al. J Cardiovasc Dev Dis. .

Abstract

Background: Aortic valve replacement (AVR) is the definitive therapy for patients with severe aortic valve stenosis (AoS). The aim of this work is to compare the effect of a mechanical prosthesis (MP) and a bioprosthesis (BP) on the survival of patients aged 50-65 years after AVR.

Methods: The retrospective analysis included 276 patients aged 50 to 65 years who had undergone isolated AVR for AoS; 161 patients were implanted with an MP and 115 with a BP. Patient survival, adjusted for age, gender and risk parameters affecting survival, was assessed. A subgroup analysis was performed on the 208 patients with a modern valve (prosthesis models that are no longer used in clinical practice were removed from the sample).

Results: After adjusting for risk factors for overall survival as well as for age and sex, the implantation of an MP did not have a significant effect on overall survival in comparison to a BP, at a median follow-up of 10.3 years (p = 0.477). The size of the MP had no significant effect on overall survival either (HR: 1.29; 95%CI: 0.16-10.21; p = 0.812). However, the indexed effective orifice area of the BP had a positive effect on overall survival (HR: 0.09; 95%CI: 0.01-0.78; p = 0.029).

Conclusions: The estimated survival of patients aged between 50 and 65 years after implantation of a BP with a sufficiently large indexed effective orifice area may exceed that of patients with an MP.

Keywords: aortic valve replacement; aortic valve stenosis; bioprosthesis; mechanical prosthesis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier estimates of the survival after surgery for patients with an MP and patients with a BP (p = 0.133) (MP—mechanical prosthesis; BP—bioprosthesis).
Figure 2
Figure 2
Graphical representation of the results of a Cox proportional hazard model (Age: (HR: 1.022; 95%CI: 0.967–1.080; p = 0.439); Female: (HR: 0.814; 95%CI: 0.507–1.307; p = 0.394); pacemaker: (HR: 8.080; 95%CI: 2.604–25.072; p < 0.001); AF: (HR: 3.323; 95%CI: 1.180–9.360; p = 0.023); DM: (HR: 1.782; 95%CI: 1.135–2.799; p = 0.012); LD: (HR: 2.127; 95%CI: 1.102–4.107; p = 0.025)) (AF—atrial fibrillation; DM—diabetes mellitus).
Figure 3
Figure 3
Estimated survival curves from a Cox proportional hazards model comparing patients with the two types of prosthesis (MP—mechanical prosthesis; BP—bioprosthesis). The models are stratified for IHD (ischemic heart disease) and the effect is adjusted for age, sex, pacemaker, AF, DM and LD. The curves are shown separately for patients without (A) and with (B) an IHD; all curves are computed for patients aged 60 years with no pacemaker, AF, DM or LD.
Figure 3
Figure 3
Estimated survival curves from a Cox proportional hazards model comparing patients with the two types of prosthesis (MP—mechanical prosthesis; BP—bioprosthesis). The models are stratified for IHD (ischemic heart disease) and the effect is adjusted for age, sex, pacemaker, AF, DM and LD. The curves are shown separately for patients without (A) and with (B) an IHD; all curves are computed for patients aged 60 years with no pacemaker, AF, DM or LD.
Figure 4
Figure 4
Estimated survival curves from a Cox proportional hazards model comparing patients with the two types of prosthesis (MP—mechanical prosthesis; BP—bioprosthesis) and different values of the iEOA (indexed effective orifice area). The model is stratified for IHD (ischemic heart disease), and the effect is adjusted for age, sex, pacemaker, AF, DM and LD. The curves are shown separately for patients without (A) and with (B) an IHD; all curves are computed for male patients aged 60 years with no pacemaker, AF, DM or LD.
Figure 4
Figure 4
Estimated survival curves from a Cox proportional hazards model comparing patients with the two types of prosthesis (MP—mechanical prosthesis; BP—bioprosthesis) and different values of the iEOA (indexed effective orifice area). The model is stratified for IHD (ischemic heart disease), and the effect is adjusted for age, sex, pacemaker, AF, DM and LD. The curves are shown separately for patients without (A) and with (B) an IHD; all curves are computed for male patients aged 60 years with no pacemaker, AF, DM or LD.
Figure 5
Figure 5
Kaplan–Meier estimates of survival after surgery for patients with a modern model of an MP and patients with a modern model of a BP (p = 0.943) (BP—bioprosthesis; MP—mechanical prosthesis).
Figure 6
Figure 6
Estimated survival curves from a Cox proportional hazards model comparing patients with the two types of prosthesis (MP—mechanical prosthesis; BP—bioprosthesis) and different values of the iEOA (indexed effective orifice area). The model is stratified for sex, and the effect is adjusted for age, pacemaker and iAVA. The curves are shown separately for male (A) and female (B) patients; all curves are computed for patients aged 60 with an iAVA value of 0.33 and no pacemaker.
Figure 6
Figure 6
Estimated survival curves from a Cox proportional hazards model comparing patients with the two types of prosthesis (MP—mechanical prosthesis; BP—bioprosthesis) and different values of the iEOA (indexed effective orifice area). The model is stratified for sex, and the effect is adjusted for age, pacemaker and iAVA. The curves are shown separately for male (A) and female (B) patients; all curves are computed for patients aged 60 with an iAVA value of 0.33 and no pacemaker.
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