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Mechanical aortic valve prostheses offer a survival benefit in 50–65 year olds: AUTHEARTVISIT study
Author(s) -
Traxler Denise,
Krotka Pavla,
Laggner Maria,
Mildner Michael,
Graf Alexandra,
Reichardt Berthold,
Wendt Ralph,
Auer Johann,
Moser Bernhard,
Mascherbauer Julia,
Ankersmit Hendrik Jan
Publication year - 2022
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.13736
Subject(s) - medicine , myocardial infarction , stroke (engine) , cohort , aortic valve replacement , population , cardiology , heart failure , aortic valve , proportional hazards model , infarction , cohort study , surgery , stenosis , mechanical engineering , environmental health , engineering
Background The present population‐based cohort study investigated long‐term mortality after surgical aortic valve replacement (AVR) with bioprosthetic (B) or mechanical aortic valve prostheses (M) in a European social welfare state. Methods We analysed patient data from health insurance records covering 98% of the Austrian population between 2010 and 2018. Subsequent patient‐level record linkage with national health data provided patient characteristics and clinical outcomes. Further reoperation, myocardial infarction, heart failure and stroke were evaluated as secondary outcomes. Results A total of 13,993 patients were analysed and the following age groups were examined separately: <50 years (727 patients: 57.77% M, 42.23% B), 50–65 years (2612 patients: 26.88% M, 73.12% B) and >65 years (10,654 patients: 1.26% M, 98.74% B). Multivariable Cox regression revealed that the use of B‐AVR was significantly associated with higher mortality in patients aged 50–65 years compared to M‐AVR (HR = 1.676 [1.289–2.181], p < 0.001). B‐AVR also performed worse in a competing risk analysis regarding reoperation (HR = 3.483 [1.445–8.396], p = 0.005) and myocardial infarction (HR = 2.868 [1.255–6.555], p = 0.012). However, the risk of developing heart failure and stroke did not differ significantly after AVR in any age group. Conclusions Patients aged 50–65 years who underwent M‐AVR had better long‐term survival, and a lower risk of reoperation and myocardial infarction. Even though anticoagulation is crucial in patients with M‐AVR, we did not observe significantly increased stroke rates in patients with M‐AVR. This evident survival benefit in recipients of mechanical aortic valve prostheses aged <65 years critically questions current guideline recommendations.