CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

September 30th, 2014

No Difference in Survival Found for Different Aortic Valve Prostheses

A new study published in JAMA suggests that younger patients who need aortic valve replacement (AVR) may now be more eligible to receive bioprosthetic valves. Each year about 50,000 people in the U.S. undergo AVR surgery. Older patients generally receive bioprosthetic valves because these valves are less prone to clotting and bleeding complications. Surgeons are often reluctant to use bioprosthetic devices in younger patients because these devices are more likely to deteriorate and require a repeat operation.

Researchers at Mt. Sinai Medical Center analyzed data from 4253 patients in New York State who were 50-69 years of age and who received a bioprosthetic or mechanical valve. After adjusting for differences in baseline risk, they compared clinical outcomes associated with the two valves in 1001 matched patient pairs.

There were no differences in mortality or stroke between the two groups. There were more reoperations in the bioprosthesis group, while there were more major bleeding episodes in the mechanical prosthesis group. Here are the cumulative 15-year rates:

  • Mortality: 60.6% in the bioprosthesis group versus 62.1% in the mechanical prosthesis group
  • Stroke: 7.7% versus 8.6%
  • Reoperation: 12.1% versus 6.9%
  • Major bleeding: 6.6% versus 13% *

“The absence of a significant survival benefit associated with one prosthesis type over another focuses decision making on lifestyle considerations, including the burden of anticoagulation medication and monitoring, and the relative risks of major morbidity—primarily stroke, reoperation, and major bleeding events,” wrote the authors.

* When originally published, the percentages for major bleeding were accidentally reversed, but have been corrected.

 

Categories: Cardiac Surgery, General
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2 Responses to “No Difference in Survival Found for Different Aortic Valve Prostheses”

  1. Abul hossain Lutful kabir, MD FRCS says:
    October 4, 2014 at 12:35 am

    for younger patients re-operation is a problem so to consider a mechanical valve

  2. John K. Forrest, MD says:
    October 7, 2014 at 1:02 pm

    Note that major bleeding was 6.6% in the bioprosthetic group and 13.1% in the mechanical group (you have the numbers switched above).
    Also interesting is that the 30-day mortality rate was 18.7% after stroke, 9.0% after reoperation, and 13.2% after major bleeding. Bleeding thus a high risk event than reoperation.
    In addition, in an era when transcatheter aortic valve replacement for degenerative surgical valves (TAV-in-SAV) has a growing amount of literature supporting its use, I would much prefer a bioprosthetic valve than a mechanical valve. When that surgical bioprosthetic valve fails, put a transcatheter valve in.