Goldstone AB, et al. - An inquiry was set up with regard to the utility of mechanical or biologic prostheses for aortic-valve and mitral-valve replacement. It was deduced that the long-term mortality benefit related to a mechanical prosthesis persisted until 70 years of age among patients undergoing mitral-valve replacement and until 55 years of age among those undergoing aortic-valve replacement, as compared with a biologic prosthesis.

Methods

• This research undertook a comparative examination of the long-term mortality and rates of reoperation, stroke, and bleeding between inverse-probability-weighted cohorts of patients who underwent primary aortic-valve replacement or mitral-valve replacement with a mechanical or biologic prosthesis.
• It was carried out in California, from 1996 to 2013.
• Patients were stratified into different age groups on the basis of valve position (aortic vs. mitral valve).

Results

• A marked rise was noted in the use of biologic prostheses for aortic-valve and mitral-valve replacement, from 11.5% to 51.6% for aortic-valve replacement and from 16.8% to 53.7% for mitral-valve replacement, from 1996 through 2013.
• A connection was disclosed between the receipt of a biologic prosthesis with considerably higher 15-year mortality than receipt of a mechanical prosthesis among patients 45 to 54 years of age (30.6% vs. 26.4% at 15 years; hazard ratio, 1.23; 95% confidence interval [CI], 1.02 to 1.48; P=0.03), among patients who underwent aortic-valve replacement but not among patients 55 to 64 years of age.
• Among patients who underwent mitral-valve replacement, a link was determined between the receipt of a biologic prosthesis with notably higher mortality than receipt of a mechanical prosthesis among patients 40 to 49 years of age (44.1% vs. 27.1%; hazard ratio, 1.88; 95% CI, 1.35 to 2.63; P < 0.001) and among those 50 to 69 years of age (50.0% vs. 45.3%; hazard ratio, 1.16; 95% CI, 1.04 to 1.30; P=0.01).
• A prominently higher incidence of reoperation was reported among recipients of a biologic prosthesis than among recipients of a mechanical prosthesis.
• It was illustrated that patients who received mechanical valves exhibited a higher cumulative incidence of bleeding and, in some age groups, stroke than did recipients of a biologic prosthesis.