Leviner DB, Witberg G, Levi A, et al. - Findings from this broadest meta-analysis comparing bioprosthetic valves (BV) and mechanical valves (MV) indicate that MV provides a survival benefit in patients < 70 years of age. This should result in re-evaluation of current patterns employed in the choice of valves for patients <70 among the cardiothoracic surgery community.

• Clinical results of patients <70 years of age receiving aortic valve replacement were assessed in this meta-analysis of randomized controlled trials (RCTs), observational studies using propensity score matching (PSM) and inverse-probability-weighing (IPW).

• Overall 15 studies (1 RCT, 12 PSM, and 2 IPW studies, aggregated sample size 16,876 patients) were analyzed with median follow-up 7.8 years.

• BV was associated with higher mortality (HR 1.22 [1.00-1.49]) and re-operation (HR 3.05 [2.22-4.19]) than MV.

• BV was associated with lower bleeding risk (HR 0.58 [0.48-0.69]), there was a similar risk of stroke in both valve types (HR 0.96 [0.83-1.11]).