Revisiting aortic valve prosthesis choice in patients younger than 50 years: 10 years results of the AUTHEARTVISIT study

Denise Traxler; Pavla Krotka; Berthold Reichardt; Dragan Copic; Cecilia Veraar; Michael Mildner; Ralph Wendt; Johann Auer; Julia Mascherbauer; Hendrik Jan Ankersmit; Alexandra Graf

doi:10.1093/ejcts/ezad308

Revisiting aortic valve prosthesis choice in patients younger than 50 years: 10 years results of the AUTHEARTVISIT study

Eur J Cardiothorac Surg. 2024 Jan 2;65(1):ezad308. doi: 10.1093/ejcts/ezad308.

Authors

Denise Traxler^{1

2

3}, Pavla Krotka⁴, Berthold Reichardt⁵, Dragan Copic^{1

2

6}, Cecilia Veraar^{2

7}, Michael Mildner⁸, Ralph Wendt⁹, Johann Auer¹⁰, Julia Mascherbauer¹¹, Hendrik Jan Ankersmit^{1

2}, Alexandra Graf⁴

Affiliations

¹ Clinic of Thoracic Surgery, Medical University of Vienna, Austria.
² Laboratory for Cardiac and Thoracic Diagnosis, Regeneration and Applied Immunology, Austria.
³ Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Austria.
⁴ Center for Medical Data Science, Medical University of Vienna, Austria.
⁵ Austrian Social Health Insurance Fund, Eisenstadt, Austria.
⁶ Division of Nephrology and Dialysis, Medical University of Vienna, Austria.
⁷ Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Austria.
⁸ Department of Dermatology, Medical University of Vienna, Austria.
⁹ Department of Nephrology, St. Georg Hospital, Leipzig, Germany.
¹⁰ Department of Internal Medicine I with Cardiology and Intensive Care, St. Josef Hospital Braunau, Braunau am Inn, Austria.
¹¹ Department of Internal Medicine 3, University Hospital St. Poelten, Austria.

Abstract

Objectives: This population-based cohort study investigated mid-term outcome after surgical aortic valve replacement with a bioprosthetic or mechanical valve prosthesis in patients aged <50 years in a European social welfare state.

Methods: We analysed patient data from the main social insurance carriers in Austria (2010-2020). Subsequent patient-level record linkage with national health data provided patient characteristics and clinical outcome. Survival, reoperation, myocardial infarction, heart failure, embolic stroke or intracerebral haemorrhage, bleeding other than intracerebral haemorrhage and major adverse cardiac events were evaluated as outcomes.

Results: A total of 991 patients were analysed. Regarding demographics, no major differences between groups were observed. Multivariable Cox regression revealed no significant difference in overall survival (P = 0.352) with a median follow-up time of 6.2 years. Reoperation-free survival was decreased (hazard ratio = 1.560 [95% CI: 1.076-2.262], P = 0.019) and the risk for reoperation was increased (hazard ratio = 2.770 [95% CI: 1.402-5.472], P = 0.003) in patients who received bioprostheses. Estimated probability of death after reoperation was 0.23 (CL: 0.08-0.35) after 2 years and 0.34 (CL: 0.06-0.53) after 10 years over both groups. Regarding further outcomes, no significant differences between the two groups were observed.

Conclusions: In patients below 50 years of age receiving aortic valve replacement, implantation of bioprostheses when compared to mechanical heart valve prostheses was associated with a significantly higher rate of reoperations and reduced reoperation-free survival. Nevertheless, we could not observe a difference in overall survival. However, long-term follow-up has to evaluate that a significantly lower rate of reoperations may translate in consistently improved long-term survival.

Keywords: Aortic valve replacement; Bioprosthesis; Mechanical aortic valve prosthesis.

MeSH terms

Aortic Valve / surgery
Bioprosthesis* / adverse effects
Cerebral Hemorrhage / etiology
Cohort Studies
Heart Valve Prosthesis Implantation* / methods
Heart Valve Prosthesis* / adverse effects
Humans
Middle Aged
Propensity Score
Prosthesis Design
Prosthesis Failure
Reoperation
Retrospective Studies
Treatment Outcome

Grants and funding

ARGE