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

Abstract

The choice of a bioprosthetic valve (BV) or mechanical valve (MV) in middle-aged adults undergoing aortic valve replacement is a complex decision that must account for numerous prosthesis and patient factors. A systematic review and meta-analysis was performed to compare long-term survival, major adverse prosthesis-related events, anticoagulant-related events, major bleeding, reoperation, and structural valve degeneration in middle-aged patients receiving a BV or MV. A comprehensive search from six electronic databases was performed from their inception to February 2016. Results from patients aged less than 70 years undergoing aortic valve replacement with a BV or MV were included. There were 12 studies involving 8,661 patients. Baseline characteristics were similar. There was no significant difference in long-term survival among patients aged 50 to 70 or 60 to 70 years. Compared with MVs, BVs had significantly fewer long-term anticoagulant-related events (hazard ratio [HR] 0.54, p = 0.006) and bleeding (HR 0.48, p < 0.00001) but significantly greater major adverse prosthesis-related events (HR 1.82, p = 0.02), including reoperation (HR 2.19, p < 0.00001). The present meta-analysis found no significant difference in survival between BVs and MVs in patients aged 50 to 70 or 60 to 70 years. Compared with MVs, BVs have reduced risk of major bleeding and anticoagulant-related events but increased risk of structural valve degeneration and reoperation. However, the mortality consequences of reoperation appear lower than that of major bleeding, and recent advances may further lower the reoperation rate for BV. Therefore, this review supports the current trend of using BVs in patients more than 60 years of age.

Sustitución valvular aórtica: ¿prótesis biológica o mecánica? Estudio comparativo de sobrevida a largo plazo

“…La relación riesgo/beneficio entre estas dos opciones es el fundamento para el uso de prótesis mecánica en pacientes menores de 50 años, según recomendación de la American Heart Association (AHA) (2) , o menores de 60 años según recomendación de la European Society of Cardiology (ESC) (3) (ambas indicaciones IIa). El uso de bioprótesis ha aumentado significativamente en las últimas décadas en todos los grupos de edad (4) .…”

“…A nivel internacional existen trabajos recientes en los cuales se comparan los resultados a largo plazo en pacientes con bioprótesis y prótesis mecáni-ca (4) . En contraste con este cuerpo de evidencia en la literatura internacional, no existen datos nacionales al respecto.…”

Coronary Stent and Prosthetic Heart Valve Information via Smartphone New Applications Improving Health-Care Quality of Patients Having Undergone Percutaneous Coronary Intervention and Artificial Valve Replacement

“…Two types of stents are used commonly for PCI; bare-metal stent and drug-eluting stent (Brodie, et al 2008). Many studies have reported that cessation of antiplatelet medications produces in-stent thrombosis in patients, O., & Bland, M. 2006) (Zhao, D. F., et al 2016). Mechanical valves are thrombogenic and therefore require life-long anticoagulation.…”

The Ross procedure: an excellent option in the right hands

“…Biologic valves (porcine, bovine, equine) have the advantage of not requiring life-long anticoagulation, but the significant disadvantage of valve deterioration requiring reintervention generally within 15-20 years (if not earlier). To make the decision between these two options more difficult, several recent studies have shown that balancing the risk-benefit ratio between these two choices in the young patient is complicated (1,2). Although the risk of reoperative AVR in the setting of a deteriorated bioprosthetic valve is higher than in the initial operation, the cumulative risk of anticoagulation, thrombosis, thromboembolism and other valve-related complications associated with a mechanical valve, make the life-time risks of valve associated morbidity and mortality for a young patient in need of an AVR relatively equal with these two options (2).…”

“…To make the decision between these two options more difficult, several recent studies have shown that balancing the risk-benefit ratio between these two choices in the young patient is complicated (1,2). Although the risk of reoperative AVR in the setting of a deteriorated bioprosthetic valve is higher than in the initial operation, the cumulative risk of anticoagulation, thrombosis, thromboembolism and other valve-related complications associated with a mechanical valve, make the life-time risks of valve associated morbidity and mortality for a young patient in need of an AVR relatively equal with these two options (2). The recent introduction of percutaneous valve-in-valve AVR technology makes the advantage of not requiring anticoagulation even more attractive for the tissue AVR.…”