Report Examines Mortality Rates for Bioprosthetic Versus Mechanical Valve Patients

Patients and their providers can use new information to help with decision-making related to bioprosthetic and mechanical valve replacement from a research study published in Circulation on March 28. Conducted by AHRQ’s DEcIDE Network, the study found that long-term mortality rates were similar for bioprosthetic versus mechanical valve replacement among patients who needed aortic valve replacement. However, the safety and effectiveness of prosthetic heart valves are highly dependent on patient age and underlying comorbidities, and the choice of an appropriate prosthesis remains complex. Select to access the study, Long-Term Safety and Effectiveness of Mechanical versus Biologic Aortic Valve Prostheses in Older Patients: Results from the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery National Database.

2013 Mar 28. [Epub ahead of print]

Long-Term Safety and Effectiveness of Mechanical versus Biologic Aortic Valve Prostheses in Older Patients: Results from the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery National Database.

Brennan JM, Edwards FH, Zhao Y, O'Brien S, Booth ME, Dokholyan RS, Douglas PS, Peterson ED; on behalf of the DEcIDE AVR Research Team.

Source

1Duke Clinical Research Institute, Durham, NC.

Abstract

BACKGROUND:

There is a paucity of long-term data comparing biologic versus mechanical aortic valve prostheses in older individuals.

METHODS AND RESULTS:

We followed patients aged 65-80 years undergoing aortic valve replacement (AVR) with a biologic (n=24,410) or mechanical prosthesis (n=14,789) from 1991-1999 at 605 centers within the Society of Thoracic Surgeons Adult Cardiac Surgery Database using Medicare inpatient claims (mean, 12.6 years; max, 17 years; min, 8 years), and outcomes were compared using propensity methods. Among Medicare-linked AVR patients (mean age, 73 years), both reoperation (4.0%) and endocarditis (1.9%) were uncommon to 12 years; however, the risk for other adverse outcomes was high, including death (66.5%), stroke (14.1%), and bleeding (17.9%). Compared with those receiving a mechanical valve, bioprosthesis patients had a similar adjusted risk for death (hazard ratio [HR] 1.04; 95% confidence interval [CI] 1.01-1.07), higher risks for reoperation (HR 2.55; 95% CI 2.14-3.03) and endocarditis (HR 1.60; 95% CI 1.31-1.94), and lower risks for stroke (HR 0.87; 95% CI 0.82-0.93) and bleeding (HR 0.66; 95% CI 0.62-0.70). While these results were generally consistent among patient subgroups, bioprosthesis patients aged 65 to 69 years had a substantially elevated 12-year absolute risk of reoperation (10.5%).

CONCLUSIONS:

Among AVR patients, long-term mortality rates were similar for bioprosthetic versus mechanical valve patients. Bioprostheses were associated with a higher long-term risk of reoperation and endocarditis, but a lower risk of stroke and hemorrhage. These risks vary as a function of a patient's age and comorbidities.