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J Chest Surg

Published online March 13, 2024

Copyright © Journal of Chest Surgery.

Mechanical versus Bioprosthetic Aortic Valve Replacement in Patients Aged 50 to 70 Years

Youngkwan Song , M.D.1, Ki Tae Kim , M.D.1, Soo Jin Park , M.D.1, Hong Rae Kim , M.D., Ph.D.1, Jae Suk Yoo , M.D., Ph.D.1, Pil Je Kang , M.D., Ph.D.1, Sung-Ho Jung , M.D., Ph.D.1, Cheol Hyun Chung , M.D., Ph.D.1, Joon Bum Kim , M.D., Ph.D.1, Ho Jin Kim , M.D., Ph.D.1

Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to:Ho Jin Kim
Tel 82-2-3010-3580
Fax 82-2-3010-6966
E-mail hjkim1978@amc.seoul.kr
ORCID
https://orcid.org/0000-0002-0809-2240

Received: October 11, 2023; Revised: December 31, 2023; Accepted: January 15, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: This study compared the outcomes of surgical aortic valve replacement (AVR) in patients aged 50 to 70 years based on the type of prosthetic valve used.
Methods: We compared patients who underwent mechanical AVR to those who underwent bioprosthetic AVR at our institution between January 2000 and March 2019. Competing risk analysis and the inverse probability of treatment weighting (IPTW) method based on propensity score were employed for comparisons.
Results: A total of 1,580 patients (984 patients with mechanical AVR; 596 patients with bioprosthetic AVR) were enrolled. There was no significant difference in early mortality between the mechanical AVR and bioprosthetic AVR groups (0.9% vs. 1.7%, p=0.177). After IPTW adjustment, the risk of all-cause mortality was significantly higher in the bioprosthetic AVR group than in the mechanical AVR group (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.07–1.80; p=0.014). Competing risk analysis revealed lower risks of stroke (sub-distributional hazard ratio [sHR], 0.44; 95% CI, 0.28–0.67; p<0.001) and anticoagulation-related bleeding (sHR, 0.35; 95% CI, 0.23–0.53; p<0.001) in the bioprosthetic AVR group. Conversely, the risk of aortic valve (AV) reintervention was higher in the bioprosthetic AVR group (sHR, 6.14; 95% CI, 3.17–11.93; p<0.001).
Conclusion: Among patients aged 50 to 70 years who underwent surgical AVR, those receiving mechanical valves showed better survival than those with bioprosthetic valves. The mechanical AVR group exhibited a higher risk of stroke and anticoagulation-related bleeding, while the bioprosthetic AVR group showed a higher risk of AV reintervention.

Keywords: Aortic valve replacement, Middle aged, Prosthetic valve, Mechanical valve, Bioprosthesis

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J Chest Surg

Published online March 13, 2024

Copyright © Journal of Chest Surgery.

Mechanical versus Bioprosthetic Aortic Valve Replacement in Patients Aged 50 to 70 Years

Youngkwan Song , M.D.1, Ki Tae Kim , M.D.1, Soo Jin Park , M.D.1, Hong Rae Kim , M.D., Ph.D.1, Jae Suk Yoo , M.D., Ph.D.1, Pil Je Kang , M.D., Ph.D.1, Sung-Ho Jung , M.D., Ph.D.1, Cheol Hyun Chung , M.D., Ph.D.1, Joon Bum Kim , M.D., Ph.D.1, Ho Jin Kim , M.D., Ph.D.1

Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to:Ho Jin Kim
Tel 82-2-3010-3580
Fax 82-2-3010-6966
E-mail hjkim1978@amc.seoul.kr
ORCID
https://orcid.org/0000-0002-0809-2240

Received: October 11, 2023; Revised: December 31, 2023; Accepted: January 15, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: This study compared the outcomes of surgical aortic valve replacement (AVR) in patients aged 50 to 70 years based on the type of prosthetic valve used.
Methods: We compared patients who underwent mechanical AVR to those who underwent bioprosthetic AVR at our institution between January 2000 and March 2019. Competing risk analysis and the inverse probability of treatment weighting (IPTW) method based on propensity score were employed for comparisons.
Results: A total of 1,580 patients (984 patients with mechanical AVR; 596 patients with bioprosthetic AVR) were enrolled. There was no significant difference in early mortality between the mechanical AVR and bioprosthetic AVR groups (0.9% vs. 1.7%, p=0.177). After IPTW adjustment, the risk of all-cause mortality was significantly higher in the bioprosthetic AVR group than in the mechanical AVR group (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.07–1.80; p=0.014). Competing risk analysis revealed lower risks of stroke (sub-distributional hazard ratio [sHR], 0.44; 95% CI, 0.28–0.67; p<0.001) and anticoagulation-related bleeding (sHR, 0.35; 95% CI, 0.23–0.53; p<0.001) in the bioprosthetic AVR group. Conversely, the risk of aortic valve (AV) reintervention was higher in the bioprosthetic AVR group (sHR, 6.14; 95% CI, 3.17–11.93; p<0.001).
Conclusion: Among patients aged 50 to 70 years who underwent surgical AVR, those receiving mechanical valves showed better survival than those with bioprosthetic valves. The mechanical AVR group exhibited a higher risk of stroke and anticoagulation-related bleeding, while the bioprosthetic AVR group showed a higher risk of AV reintervention.

Keywords: Aortic valve replacement, Middle aged, Prosthetic valve, Mechanical valve, Bioprosthesis

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