Ten-year comparison of pericardial tissue valves versus mechanical prostheses for aortic valve replacement in patients younger than 60 years of age

Weber, Alberto; Noureddine, Hassan; Englberger, Lars; Dick, Florian; Gahl, Brigitta; Aymard, Thierry; Czerny, Martin; Tevaearai, Hendrik T.; Stalder, Mario; Carrel, Thierry

doi:10.1016/j.jtcvs.2012.01.024

Cited by 138 publications

(98 citation statements)

References 42 publications

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“…22 Weber et al also noted a reduced mid-term survival among patients treated with BP, with similar valve-related event rates in both age group and concluded that current evidence remains insufficient to recommend BP for AVR in patients under 60 years of age. 23 Although these data also support the present conclusions, patients treated with MP have a potential risk of bleeding events due to anticoagulation as they age. 24 Newly available anticoagulants, such as rivaroxaban and apixaban, may become strong alternatives to warfarin for reducing the rate of bleeding and thromboembolic complications associated with MP, although another new anticoagulant, dabigatran, has recently been prohibited for use in patients with MP.…”

Section: Disclosuressupporting

confidence: 79%

Long-Term Results of Aortic Valve Replacement With Mechanical Prosthesis or Carpentier-Edwards Perimount Bioprosthesis in Japanese Patients According to Age

Nishida

Sonoda

Oishi

et al. 2014

Circ J

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College of Cardiology guidelines revised in 2014 recommend BP for the patients aged >70 years, mechanical prosthesis (MP) for the patients aged <60 years, and either a BP or MP for the patients aged 60-70 years. 7 Due to the lack, however, of longterm results for the use of BP in AVR 8 and the small number of comparative studies 9 of different age groups in Japan, it remains debatable as to which type of prosthesis, BP or MP, is better for AVR in Japanese patients in their 60 s.The purpose of this study was to analyze our 30-year clinical experience with bileaflet MP and Carpentier-Edwards Perimount (CEP) BP for AVR in different age groups in order to clarify the optimal age for using BP for AVR. MethodsThis study involved human subjects and was reviewed and approved by the Institutional Review Board at Kyushu University. Between 4 November 1981 and 16 December 2013, 737 patients underwent AVR excluding aortic root replacement with bileaflet MP (n=424) or CEP BP (Edwards Lifesciences, Irvine, CA, he use of bioprostheses (BP) has been increasing worldwide along with improvements in durability. 1,2 The use of BP in Japan soared from 9.6% (707/7,364) in 1996 3 to 64.3% (9,832/15,284 valves) in 2011. 4 In our previous study, however, we found that the use of BP should be delayed until 70 years of age in the case of mitral valve replacement (MVR) in Japanese patients. 5 Editorial p 2627The European Society of Cardiology and the European Association for Cardio-Thoracic Surgery guidelines revised in 2012 indicate that the use of BP for aortic valve replacement (AVR) should be considered in patients aged >65 years (class IIa) and both valves are acceptable, and the choice requires careful analysis of factors other than age in patients aged 60-65. 6 The guidelines published by the Japanese Circulation Society in 2012 also recommend the use of BP in patients aged ≥65 years if the patient has no risk of thromboembolism (class I). Recently, the American Heart Association and American T Conclusions:The use of BP is suitable in patients aged ≥70 years, while the use of bileaflet MP is preferable in patients aged <60 years. Among patients aged 60-69 years, the use of BP is acceptable because of the lower incidence of anticoagulant-related events and the equivalent long-term survival. (Circ J 2014; 78: 2688 -2695

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Section: Disclosuressupporting

confidence: 79%

Long-Term Results of Aortic Valve Replacement With Mechanical Prosthesis or Carpentier-Edwards Perimount Bioprosthesis in Japanese Patients According to Age

Nishida

Sonoda

Oishi

et al. 2014

Circ J

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“…Weber et al found that mechanical valves (SJM or ATS bi-leaflet mechanical valves) in the aortic position were associated with better 10-year survival compared with bioprosthetic (CEP) valves in patients aged <60 years. 12 They reported that the survival advantage seemed related to the better hemodynamic performance of the mechanical valves and/or the protective effect of long-term anticoagulation. Furthermore, Brown et al reported improved long-term outcomes with mechanical valves (SJM) compared with bioprosthetic valves (CEP) in patients aged 50-70 years on propensitymatched analysis from the Mayo Clinic database.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Long-Term Outcomes of Mechanical and Bioprosthetic Aortic Valves　― A Propensity Score Analysis ―

Minakata

Tanaka

Tamura

et al. 2017

Circ J

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of age, either type of valve prosthesis can be chosen. The aim of this study was to assess the mortality and valverelated complications and compare the long-term outcomes of mechanical vs. bioprosthetic valves in Japanese patients undergoing aortic valve replacement (AVR) stratified into 3 age groups (<60 years; 60-69 years, and ≥70 years). Methods PatientsThis study was a pooled analysis of 2 large retrospective T he American College of Cardiology/American Heart Association (ACC/AHA) recently published their revised guidelines on the selection of prosthetic valves. 1 According to their class I recommendation, patient values and preferences must be taken into account, based on full disclosure and understanding of the indications for anticoagulant therapy and the potential need for and risk of reoperation. Besides patient preference, age has been one of the most important factors influencing prosthetic valve choice: mechanical valves are recommended for patients <60 years of age, and bioprosthetic valves for those >70 years of age. For those between 60 and 70 years Background: The aim of this study was to assess the long-term outcomes of aortic valve replacement (AVR) with either mechanical or bioprosthetic valves according to age at operation.

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“…Survival was significantly reduced in patients after biologic aortic valve replacement (90.3% vs 98%; P = 0.038) [22]. The latest trial by a Swedish group showed the same results with better long-term survival in patients aged 50-69 years after AVR with mechanical valves compared with those who had received bioprostheses.…”

mentioning

confidence: 83%

Mechanical versus biological aortic valve replacement strategies

Reineke

Gisler

Englberger

et al. 2016

Expert Review of Cardiovascular Therapy

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Aortic valve replacement (AVR) is the most frequently performed procedure in valve surgery.The controversy about the optimal choice of the prosthetic valve is as old as the technique itself. Currently there is no perfect valve substitute available. The main challenge is to choose between mechanical and biological prosthetic valves. Biological valves include pericardial (bovine, porcine or equine) and native porcine bioprostheses designed in stented or stentless versions. Homografts and pulmonary autografts are reserved for special indications and will not be discussed in detail in this review. We will focus on the decision making between artificial biological and mechanical prostheses, respectively.The first part of this article reviews guideline recommendations concerning the choice of aortic prostheses in different clinical situations while the second part is focused on novel strategies in the treatment of patients with aortic valve pathology.Keywords: aortic valve replacement, biological valve prosthesis, mechanical valve prosthesis, oral anticoagulation, novel oral anticoagulants. Current EvidenceThe current guidelines of the European Society of Cardiology from 2012 [1] and of the American Heart Association from 2014 [2] uniformly recommend mechanical aortic valve replacement (AVR) in patients under 60 years of age and biologic AVR in patients over 70 years of age (Fig. 1). In patients between 60 and 70 years of age, recommendations are conflicting. The ESC-Guidelines recommend biologic prosthesis from the age of 65 years onwards, whereas the newer AHA/ACC guidelines only recommend biological valves starting with 70 years of age. Looking at the development of the guidelines over the last 20 years there is a shift away from a clear-cut age limit towards the patients wish and life-style considerations.Currently there is a trend towards more biological AVR, also in patients under 65 years of age, which is contrary to the progress of life expectancy of patients at this age.Justification for this approach is the option for a valve-in-valve procedure in the case of structural valve deterioration (SVD) which might become a routine bail out strategy. In addition, the last generation of pericardial tissue valves may have excellent long-term durability over 20 years. However, current studies also demonstrate a significant age-

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Ten-year comparison of pericardial tissue valves versus mechanical prostheses for aortic valve replacement in patients younger than 60 years of age

Cited by 138 publications

References 42 publications

Long-Term Results of Aortic Valve Replacement With Mechanical Prosthesis or Carpentier-Edwards Perimount Bioprosthesis in Japanese Patients According to Age

Long-Term Results of Aortic Valve Replacement With Mechanical Prosthesis or Carpentier-Edwards Perimount Bioprosthesis in Japanese Patients According to Age

Comparison of the Long-Term Outcomes of Mechanical and Bioprosthetic Aortic Valves　― A Propensity Score Analysis ―

Mechanical versus biological aortic valve replacement strategies

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Ten-year comparison of pericardial tissue valves versus mechanical prostheses for aortic valve replacement in patients younger than 60 years of age

Cited by 138 publications

References 42 publications

Long-Term Results of Aortic Valve Replacement With Mechanical Prosthesis or Carpentier-Edwards Perimount Bioprosthesis in Japanese Patients According to Age

Long-Term Results of Aortic Valve Replacement With Mechanical Prosthesis or Carpentier-Edwards Perimount Bioprosthesis in Japanese Patients According to Age

Comparison of the Long-Term Outcomes of Mechanical and Bioprosthetic Aortic Valves ― A Propensity Score Analysis ―

Mechanical versus biological aortic valve replacement strategies

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Comparison of the Long-Term Outcomes of Mechanical and Bioprosthetic Aortic Valves　― A Propensity Score Analysis ―