Revisiting aortic valve prosthesis choice in patients younger than 50 years : 10 years results of the AUTHEARTVISIT study
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery..
OBJECTIVES: This population-based cohort study investigated mid-term outcome after surgical aortic valve replacement with a bioprosthetic or mechanical valve prosthesis in patients aged <50 years in a European social welfare state.
METHODS: We analysed patient data from the main social insurance carriers in Austria (2010-2020). Subsequent patient-level record linkage with national health data provided patient characteristics and clinical outcome. Survival, reoperation, myocardial infarction, heart failure, embolic stroke or intracerebral haemorrhage, bleeding other than intracerebral haemorrhage and major adverse cardiac events were evaluated as outcomes.
RESULTS: A total of 991 patients were analysed. Regarding demographics, no major differences between groups were observed. Multivariable Cox regression revealed no significant difference in overall survival (P = 0.352) with a median follow-up time of 6.2 years. Reoperation-free survival was decreased (hazard ratio = 1.560 [95% CI: 1.076-2.262], P = 0.019) and the risk for reoperation was increased (hazard ratio = 2.770 [95% CI: 1.402-5.472], P = 0.003) in patients who received bioprostheses. Estimated probability of death after reoperation was 0.23 (CL: 0.08-0.35) after 2 years and 0.34 (CL: 0.06-0.53) after 10 years over both groups. Regarding further outcomes, no significant differences between the two groups were observed.
CONCLUSIONS: In patients below 50 years of age receiving aortic valve replacement, implantation of bioprostheses when compared to mechanical heart valve prostheses was associated with a significantly higher rate of reoperations and reduced reoperation-free survival. Nevertheless, we could not observe a difference in overall survival. However, long-term follow-up has to evaluate that a significantly lower rate of reoperations may translate in consistently improved long-term survival.
| Errataetall: |
CommentIn: Eur J Cardiothorac Surg. 2024 Mar 1;65(3):. - PMID 38409674 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:65 |
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| Enthalten in: |
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery - 65(2024), 1 vom: 02. Jan. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Traxler, Denise [VerfasserIn] |
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| Links: |
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| Themen: |
Aortic valve replacement |
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| Anmerkungen: |
Date Completed 04.01.2024 Date Revised 19.03.2024 published: Print CommentIn: Eur J Cardiothorac Surg. 2024 Mar 1;65(3):. - PMID 38409674 Citation Status MEDLINE |
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| doi: |
10.1093/ejcts/ezad308 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Revisiting aortic valve prosthesis choice in patients younger than 50 years |b 10 years results of the AUTHEARTVISIT study |
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| 500 | |a CommentIn: Eur J Cardiothorac Surg. 2024 Mar 1;65(3):. - PMID 38409674 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. | ||
| 520 | |a OBJECTIVES: This population-based cohort study investigated mid-term outcome after surgical aortic valve replacement with a bioprosthetic or mechanical valve prosthesis in patients aged <50 years in a European social welfare state | ||
| 520 | |a METHODS: We analysed patient data from the main social insurance carriers in Austria (2010-2020). Subsequent patient-level record linkage with national health data provided patient characteristics and clinical outcome. Survival, reoperation, myocardial infarction, heart failure, embolic stroke or intracerebral haemorrhage, bleeding other than intracerebral haemorrhage and major adverse cardiac events were evaluated as outcomes | ||
| 520 | |a RESULTS: A total of 991 patients were analysed. Regarding demographics, no major differences between groups were observed. Multivariable Cox regression revealed no significant difference in overall survival (P = 0.352) with a median follow-up time of 6.2 years. Reoperation-free survival was decreased (hazard ratio = 1.560 [95% CI: 1.076-2.262], P = 0.019) and the risk for reoperation was increased (hazard ratio = 2.770 [95% CI: 1.402-5.472], P = 0.003) in patients who received bioprostheses. Estimated probability of death after reoperation was 0.23 (CL: 0.08-0.35) after 2 years and 0.34 (CL: 0.06-0.53) after 10 years over both groups. Regarding further outcomes, no significant differences between the two groups were observed | ||
| 520 | |a CONCLUSIONS: In patients below 50 years of age receiving aortic valve replacement, implantation of bioprostheses when compared to mechanical heart valve prostheses was associated with a significantly higher rate of reoperations and reduced reoperation-free survival. Nevertheless, we could not observe a difference in overall survival. However, long-term follow-up has to evaluate that a significantly lower rate of reoperations may translate in consistently improved long-term survival | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Aortic valve replacement | |
| 650 | 4 | |a Bioprosthesis | |
| 650 | 4 | |a Mechanical aortic valve prosthesis | |
| 700 | 1 | |a Krotka, Pavla |e verfasserin |4 aut | |
| 700 | 1 | |a Reichardt, Berthold |e verfasserin |4 aut | |
| 700 | 1 | |a Copic, Dragan |e verfasserin |4 aut | |
| 700 | 1 | |a Veraar, Cecilia |e verfasserin |4 aut | |
| 700 | 1 | |a Mildner, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Wendt, Ralph |e verfasserin |4 aut | |
| 700 | 1 | |a Auer, Johann |e verfasserin |4 aut | |
| 700 | 1 | |a Mascherbauer, Julia |e verfasserin |4 aut | |
| 700 | 1 | |a Ankersmit, Hendrik Jan |e verfasserin |4 aut | |
| 700 | 1 | |a Graf, Alexandra |e verfasserin |4 aut | |
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