• Kenji Minakata, Shiro Tanaka, Nobushige Tamura, Shigeki Yanagi, Yohei Ohkawa, Shuichi Okonogi, Tatsuo Kaneko, Akihiko Usui, Tomonobu Abe, Mitsuomi Shimamoto, Yoshiharu Takahara, Kazuo Yamanaka, Hitoshi Yaku, and Ryuzo Sakata.
• Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine.
• Circ. J. 2017 Jul 25; 81 (8): 1198-1206.

BackgroundThe aim of this study was to assess the long-term outcomes of aortic valve replacement (AVR) with either mechanical or bioprosthetic valves according to age at operation.Methods and Results:A total of 1,002 patients (527 mechanical valves and 475 bioprosthetic valves) undergoing first-time AVR were categorized according to age at operation: group Y, age <60 years; group M, age 60-69 years; and group O, age ≥70 years). Outcomes were compared on propensity score analysis (adjusted for 28 variables). Hazard ratio (HR) was calculated using the Cox regression model with adjustment for propensity score with bioprosthetic valve as a reference (HR=1). There were no significant differences in overall mortality between mechanical and bioprosthetic valves for all age groups. Valve-related mortality was significantly higher for mechanical valves in group O (HR, 2.53; P=0.02). Reoperation rate was significantly lower for mechanical valves in group Y (HR, 0.16; P<0.01) and group M (no events for mechanical valves). Although the rate of thromboembolic events was higher in mechanical valves in group Y (no events for tissue valves) and group M (HR, 9.05; P=0.03), there were no significant differences in bleeding events between all age groups.ConclusionsThe type of prosthetic valve used in AVR does not significantly influence overall mortality.

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