This systematic review and meta-analysis evaluated outcomes after aortic valve replacement in patients aged 50 to 70 years, including 30 studies and more than 120,000 patients. The findings indicated that mechanical valves were associated with improved long-term survival (approximately 12 percent relative reduction in mortality) compared with bioprosthetic valves. Stroke rates were similar between the groups. However, mechanical valves had a significantly higher risk of major bleeding, reflecting the need for lifelong anticoagulation, while bioprosthetic valves were associated with substantially higher reoperation rates due to structural valve degeneration. The evidence base was predominantly observational, with only one randomized trial, limiting causal inference. Despite this, international practice is shifting toward increased use of bioprosthetic valves in this age group, likely driven by patient preference and evolving transcatheter options, but without robust long-term randomized evidence to support this trend.
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Mechanical Versus Biological Aortic Valve Replacement in Patients Aged 50-70 Years: A Systematic Review and Meta-Analysis
Submitted by: Jason Trevis
Source: Heart
Source URL: https://pubmed.ncbi.nlm.nih.gov/41850787/
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Author(s): Jason Trevis, Jeremy Cheong, Chris Wilkinson, Emmanuel Ogundimu, Rebecca Maier, David Austin, Enoch Akowuah
1 Comment
If you used only On-X valves for the mechanical AoV replacement cohort, I suspect that the increased incidence of major bleeding would disappear, given that the PROACT trial demonstrated that On-X in aortic position, even in patients with atrial fibrillation, could safely maintain INR at 1.5. In the 50-70 yr.age group, a significant number of bioprosthetic valve recipients are either already on VKA or NOAC/DOAC preoperatively, or soon to be postoperatively due to AFib alone. Many surgeons adhere blindly to the IFR in the bioprosthetic valves for 90 days of anticoagulation at INR 2.5 range, even though it is a practice unsupported by EBM.