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16. Biological or mechanical prostheses for isolated aortic valve replacement in patients aged 50-65 years: the ANDALVALVE study

Author

Edwards Lifesciences, Rodríguez-Caulo, Emiliano A., Macías, Diego, Adsuar-Gómez, Alejandro, Ferreiro, Andrea, Arias-Dachary, Javier, Parody, Gertrudis, Fernández, Frank, Daroca, Tomás, Rodríguez-Mora, Felipe, Garrido, José M., Muñoz-Carvajal, Ignacio, Barquero, José M., Valderrama, José F., Melero, José M., Edwards Lifesciences, Rodríguez-Caulo, Emiliano A., Macías, Diego, Adsuar-Gómez, Alejandro, Ferreiro, Andrea, Arias-Dachary, Javier, Parody, Gertrudis, Fernández, Frank, Daroca, Tomás, Rodríguez-Mora, Felipe, Garrido, José M., Muñoz-Carvajal, Ignacio, Barquero, José M., Valderrama, José F., and Melero, José M.

Abstract

[Objectives]: The decision about whether to use a biological or a mechanical prosthesis for aortic valve replacement remains controversial in patients between 50 and 65 years of age and has yet to be addressed in a Mediterranean population. This research aimed to analyse long-term survival and major morbidity rates (30-day mortality, stroke, any prosthetic reoperation and major bleeding) within this population. [Methods]: Our multicentre observational retrospective study included all subjects aged 50–65 years who had a primary isolated aortic valve replacement due to severe aortic stenosis at 7 public hospitals from Andalusia (Spain) between 2000 and 2015. Concomitant surgery, reoperations and endocarditis were the exclusion criteria. A total of 1443 patients were enrolled in the study (272 with biological and 1171 with mechanical valves). Multivariate analyses including a 2:1 propensity score matching (506 mechanical and 257 biological prostheses) were conducted. [Results]: Bioprostheses were implanted in 18.8% (n = 272): 35% were women; the mean EuroSCORE-I was 3%. The mean follow-up was 8.1 ± 4.9 years in a matched sample: 8.8 ± 4.9 years in those receiving a mechanical vs 7.1 ± 4.5 years in those receiving a biological prosthesis (P = 0.001). In the paired sample, the 15-year survival rate was 73% in those who had a biological vs 76% in those who had a mechanical valve [hazard ratio (HR) 0.80, 95% confidence interval (CI) 0.54–1.20; P = 0.159]. No significant differences were observed in patients ≥55 years old (74% of 15-year survival in both groups: HR 0.88, 95% CI 0.56–1.34; P = 0.527). A higher rate of major bleeding was found in patients with a mechanical prosthesis (P = 0.004), whereas reoperation was more frequent among those with a biological prosthesis (P = 0.01). [Conclusions]: Long-term survival was comparable in patients above 55 years of age. Mechanical prostheses were associated with more major bleeding and bioprostheses, with more reoperations. A b

Published
2019

17. Biological or mechanical prostheses for isolated aortic valve replacement in patients aged 50–65 years: the ANDALVALVE study

Author

Rodríguez-Caulo, Emiliano A, primary, Macías, Diego, additional, Adsuar, Alejandro, additional, Ferreiro, Andrea, additional, Arias-Dachary, Javier, additional, Parody, Gertrudis, additional, Fernández, Frank, additional, Daroca, Tomás, additional, Rodríguez-Mora, Felipe, additional, Garrido, José M, additional, Muñoz-Carvajal, Ignacio, additional, Barquero, José M, additional, Valderrama, José F, additional, and Melero, José M, additional

Published
2019
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23. Reply

Author

Mataró, María J., primary, Sánchez-Espín, Gemma, additional, Porras, Carlos, additional, Melero, José M., additional, Guzón, Arantza, additional, and Such, Miguel, additional

Published
2013
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30. Reply: To PMID 23336891.

Author

Mataró MJ, Sánchez-Espín G, Porras C, Melero JM, Guzón A, and Such M

Subjects
Female, Humans, Coronary Artery Bypass methods, Stents
Published
2013
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