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Very long-term survival implications of heart valve replacement with tissue versus mechanical prostheses in adults

Abstract：

BACKGROUND:Several centers favor replacing a diseased native heart valve with a tissue rather than a mechanical prosthesis, even in younger adult patients. However, long-term data supporting this approach are lacking. We examined the survival implications of selecting a tissue versus a mechanical prosthesis at initial left-heart valve replacement in a cohort of adults <60 years of age who were followed for over 20 years. METHODS AND RESULTS:Comorbid and procedural data were available from 6554 patients who underwent valve replacement at our institution over the last 35 years. Of these, 1512 patients contributed follow-up data beyond 20 years, of whom 567 were adults <60 years of age at first left-heart valve operation (mean survivor follow-up, 24.0+/-3.1 years). Late outcomes were examined with Cox regression. Valve reoperation, often for prostheses that are no longer commercially available, occurred in 89% and 84% of patients by 20 years after tissue aortic and mitral valve replacement, respectively, and was associated with a mortality of 4.3%. There was no survival difference between patients implanted with a tissue versus a mechanical prosthesis at initial aortic valve replacement (hazard ratio 0.95; 95% CI: 0.7, 1.3; P=0.7). For mitral valve replacement patients, long-term survival was poorer than after aortic valve replacement (hazard ratio 1.4; 95% CI: 1.1, 1.8; P=0.003), but again no detrimental effect was associated with use of a tissue versus a mechanical prosthesis (hazard ratio 0.9; 95% CI 0.5, 1.4; P=0.5). CONCLUSIONS:In our experience, selecting a tissue prosthesis at initial operation in younger adults does not negatively impact survival into the third decade of follow-up, despite the risk of reoperation.

journal_name

Circulation

journal_title

Circulation

authors

Ruel M,Chan V,Bédard P,Kulik A,Ressler L,Lam BK,Rubens FD,Goldstein W,Hendry PJ,Masters RG,Mesana TG

doi

10.1161/CIRCULATIONAHA.106.681429

subject

Has Abstract

pub_date

2007-09-11 00:00:00

pages

I294-300

issue

11 Suppl

eissn

0009-7322

issn

1524-4539

pii

116/11_suppl/I-294

journal_volume

116

pub_type

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Very long-term survival implications of heart valve replacement with tissue versus mechanical prostheses in adults