Survival and Long-Term Outcomes of Aortic Valve Replacement in Patients Aged 55 to 65 Years

BACKGROUND: This study aims to compare the outcomes after aortic valve replacement (AVR) with mechanical and biological valves in middle-aged patients (55-65 years) to determine the impact on long-term mortality and morbidity. METHODS: A retrospective analysis of 373 patients between 55 and 65 years of age who received a primary AVR with or without concomitant coronary artery bypass graft between April 1995 and March 2014. Propensity matching yielded 118 patient pairs in the mechanical and biological valve cohorts. RESULTS: Median follow-up time was 6.9 years. No differences in long-term survival or a composite outcome of stroke, bleeding, and endocarditis (major adverse prosthesis-related event; MAPE) were observed in patients receiving biological versus mechanical valves. Actuarial 15-year survival was 46.4% (95% confidence interval [CI], 28.8-62.3%) in the biological valve group versus 60.6% (95% CI, 47.5-71.4%) in the mechanical valve group (hazard ratio, 1.16 [95%CI, 0.69-1.94], p = 0.58). The 15-year cumulative incidence of MAPE was 53.3% (95% CI, 33.7-69.4%) for biological valves versus 24.5% (95% CI, 16.2-33.8%) for mechanical valves (hazard ratio, 0.65 [95% CI, 0.37-1.14], p = 0.12). The 15-year cumulative incidence of reoperation was higher in the bioprosthetic group (26.0% [95% CI, 14.0-39.8%] vs. 5.4% [95% CI, 2.0-11.4%]; hazard ratio 0.24 [95% CI, 0.09-0.68] p < 0.01). CONCLUSION: There is no difference in survival and MAPE at 15 years between biological and mechanical valves. The risk of reoperation was significantly higher in the biological valve group and may affect valve choice in middle-aged patients.