Aortic valve replacement in patients aged 50 to 69 years: Analysis using Korean National Big Data

Abstract

Background The aim of this study was to compare the clinical outcomes and long‐term survival in patients who underwent isolated aortic valve replacement (AVR) with mechanical versus bioprosthetic valves. Methods Patients aged 50–69 years who had undergone AVR from 2002 to 2018 were identified and their characteristics were collected from Korean National Health Information Database formed by the National Health Insurance Service, Republic of Korea. Of the 5792 patients, 1060 patients were excluded due to missing values on characteristics. Of the 4732 study patients, 1945 patients (41.1%) had received bioprosthetic valves (Group B) and 2787 patients (58.9%) had received mechanical valves (Group M). A propensity score‐matched analysis was performed to match 1429 patients in each group. Data on mortality, cardiac mortality, reoperations, cerebrovascular accidents, and bleeding complications were obtained. Results The overall survival rates at 5 and 10 years postoperatively were 87.8% and 75.2% in the matched Group B and 91.2% and 76.7% in the matched Group M, respectively (p = .140). Freedom from cardiac death rates at postoperative 5 and 10 years were 95.6% and 92.4% in the matched Group B and 96.0% and 92.1% in the matched Group M, respectively (p = .540). The cumulative incidence of reoperation was higher in the matched Group B than in the matched Group M (p = .007), and the cumulative incidence of major bleeding was higher in the matched Group M than in the matched Group B (p = .039). Conclusion In patients aged 50–69 years who underwent isolated AVR, the patients who received bioprosthetic valves showed similar cardiac mortality‐free survival and long‐term survival rates to the patients who received mechanical valves.

Mechanical versus Bioprosthetic Aortic Valve Replacement in Middle-Aged Adults: A Systematic Review and Meta-Analysis

“…In total, 22 studies were included in the final analysis, and the characteristics of the individual studies are summarized in Table 1 . Of those studies, one was an RCT study [ 8 ], 11 were PSM retrospective studies [ 1 , 3 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ], and 10 were non-PSM retrospective studies [ 7 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. In total, 32,298 patients were included, of which 15,449 received mechanical prostheses, whereas 16,849 received biological prostheses.…”

“…Early death refers to in-hospital death or death occurring within 30 days after operation. In total, 14 [ 3 , 7 , 8 , 13 , 15 , 16 , 19 , 20 , 21 , 22 , 23 , 24 , 26 , 27 ] studies provided related details, 7 [ 3 , 8 , 13 , 15 , 16 , 19 , 20 ] of which were RCT or PSM retrospective studies. No significant difference in early mortality existed between mechanical and bioprosthetic prostheses regardless of whether only RCT or PSM retrospective studies were included.…”

“…Dates for long-term survival were available for 20 studies [ 1 , 3 , 8 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 28 , 29 ], 12 [ 1 , 3 , 8 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ] of which were RCT or PSM retrospective studies. There was strong evidence favoring mechanical prostheses over bioprosthetic prostheses regardless of whether only RCT or PSM retrospective studies were included.…”

“…Only three studies [ 8 , 14 , 16 ] were included in this analysis, all of which were RCT or PSM retrospective studies. No difference in freedom from cardiac death was observed.…”

Valve choice for aortic valve replacement in patients between 50 and 70 years of age

“…However, between the age of 50 and 65 there seems to be an equipoise regarding the choice between a bio‐prosthetic and mechanical valve and decision‐making centers around patient choice and patient related factors. As a result the current study by Kim et al 3 seems extremely relevant in the context.…”