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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
The Journal of Cardiovascular Surgery 2014 Sep 12
Isolated Aortic Valve Replacement with bio-prostheses in patients age 50 to 65 years: a decade of statewide data on cost and patient outcomes
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.