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Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
Online ISSN 1827-191X
Quader M. 1, Wolfe L. 1, Medina A. 1, Fonner C. 2, Ailawadi G. 3, Crosby I. 3, Speir A. 4, Rich J. 5, Lapar D. 3, Kasirajan V. 1
1 Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond VA, USA;
2 Aramus Corporation, San Mateo CA, USA;
3 Division of Cardiothoracic Surgery, University of Virginia Health Sciences, Charlottesville VA, USA;
4 Cardiovascular and Thoracic Associates, Falls Church VA, USA;
5 Mid Atlantic Cardiothoracic Surgery Ltd. Norfolk VA, USA
AIM: Guidelines for choice of replacement valve- mechanical versus bioprosthetic, are well established for patients aged <50 and >65 years. We studied the trends and implications of aortic valve replacement (AVR) with mechanical versus bioprosthetic valve in patients aged 50 to 65 years.
METHODS: STS and cost database of 17 centers for isolated AVR surgery were analyzed by dividing them into Bioprosthetic Valve (BV) or Mechanical Valve (MV) groups.
RESULTS: From 2002 to 2011, 3,690 patients had AVR, 18.6% with MV and 81.4% with BV. Use of BV for all ages increased from 71.5% in 2002 to 87% in 2011. There were 1127 (30.5%) patients in the age group 50-65 years. Use of BV in this group almost doubled, 39.6% in 2002 to 76.8% in 2011. Mean age of patients in BV group was higher (59.2±4.2 years vs. 56.7±4.3years, P=<0.0001). Preoperative renal failure, heart failure and COPD favored use of BV, whereas preoperative atrial fibrillation favored AVR with MV. Mortality (MV 2.2% vs. BV 2.36%) and other postoperative outcomes between the groups were similar. Cost of valve replacement increased for both groups (MV $26,191 in 2002 to $42,592 in 2011; BV $27,404 in 2002 to $44,257 in 2011).
CONCLUSIONS: Use of bioprostheses for AVR has increased; this change is more pronounced in patients aged 50-65 years. Specific preoperative risk factors influence the choice of valve for AVR. Postoperative outcomes between the two groups were similar. Long-term implications of this changing practice, in particular, reoperation for bioprosthetic valve degeneration should be examined.