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• W3133026298 abstract "Central MessageBioprosthesis is an excellent option for young patients who undergo isolated AVR. Although reintervention is higher than mechanical, mortality associated with re-do AVR did not affect survival.See Article page 609. Bioprosthesis is an excellent option for young patients who undergo isolated AVR. Although reintervention is higher than mechanical, mortality associated with re-do AVR did not affect survival. See Article page 609. Differential benefits and risks with the use of bioprostheses and mechanical aortic valves are an issue of debate, and any large registry data that address these issues are always novel and welcome. Rodriguez-Caulo and colleagues1Rodriguez-Caulo E.A. Blanco-Herrera O. Berastegui E. Arias-Dachary J. Souaf S. Parody G. et al.SPAVALVE study groupBiological versus mechanical prostheses for aortic valve replacement.J Thorac Cardiovasc Surg. 2023; 165: 609-617.e7Abstract Full Text Full Text PDF Scopus (7) Google Scholar evaluated survival and major adverse cardiac events as primary outcomes in a large registry that included 50- to 65-year-old patients who underwent isolated aortic valve replacement (AVR) from 2000 to 2018 at 27 hospitals in Spain. Propensity matching (2:1) yielded 1822 patients with a mechanical prosthesis and 911 patients with a bioprosthesis. After a median of 6-8 years, survival was similar between both groups. Patients with a mechanical prosthesis had a higher risk for bleeding, and patients with a bioprosthesis had a higher risk for reintervention.1Rodriguez-Caulo E.A. Blanco-Herrera O. Berastegui E. Arias-Dachary J. Souaf S. Parody G. et al.SPAVALVE study groupBiological versus mechanical prostheses for aortic valve replacement.J Thorac Cardiovasc Surg. 2023; 165: 609-617.e7Abstract Full Text Full Text PDF Scopus (7) Google Scholar When evaluating long-term survival in patients with a bioprosthesis versus mechanical prosthesis through retrospective studies, it is critical to distinguish if included patients underwent isolated AVR or not. Patients aged 50-65 years who require coronary artery bypass grafting (CABG) might receive a mechanical prosthesis to avoid reintervention with patent grafts. This portrays a strong selection bias difficult to adjust by propensity match. Kytö and colleagues2Kytö V. Sipilä J. Ahtela E. Rautava P. Gunn J. Mechanical versus biologic prostheses for surgical aortic valve replacement in patients aged 50 to 70.Ann Thorac Surg. 2020; 110: 102-110Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar recently showed that 10-year all-cause mortality was higher in patients with a bioprosthesis in a retrospective study. Although the 10-year mortality in those with a mechanical valve in the study by Kytö and colleagues2Kytö V. Sipilä J. Ahtela E. Rautava P. Gunn J. Mechanical versus biologic prostheses for surgical aortic valve replacement in patients aged 50 to 70.Ann Thorac Surg. 2020; 110: 102-110Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar (18.6%) was similar to that in the study by Rodriguez-Caulo and colleagues1Rodriguez-Caulo E.A. Blanco-Herrera O. Berastegui E. Arias-Dachary J. Souaf S. Parody G. et al.SPAVALVE study groupBiological versus mechanical prostheses for aortic valve replacement.J Thorac Cardiovasc Surg. 2023; 165: 609-617.e7Abstract Full Text Full Text PDF Scopus (7) Google Scholar (17%), this was not the case for the bioprosthesis (27.6% and 19%, respectively). The main difference between the studies by Rodriguez-Caulo and colleagues1Rodriguez-Caulo E.A. Blanco-Herrera O. Berastegui E. Arias-Dachary J. Souaf S. Parody G. et al.SPAVALVE study groupBiological versus mechanical prostheses for aortic valve replacement.J Thorac Cardiovasc Surg. 2023; 165: 609-617.e7Abstract Full Text Full Text PDF Scopus (7) Google Scholar and Kytö and colleagues2Kytö V. Sipilä J. Ahtela E. Rautava P. Gunn J. Mechanical versus biologic prostheses for surgical aortic valve replacement in patients aged 50 to 70.Ann Thorac Surg. 2020; 110: 102-110Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar is the inclusion of concomitant CABG in the latter. Hirji and colleagues3Hirji S.A. Kolkailah A.A. Ramirez-Del Val F. Lee J. McGurk S. Pelletier M. et al.Mechanical versus bioprosthetic aortic valve replacement in patients aged 50 years and younger.Ann Thorac Surg. 2018; 106: 1113-1120Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar found no difference in survival between bioprosthesis and mechanical groups in a young cohort of patients with a low incidence of CABG. A recent meta-analysis comparing bioprosthesis and mechanical groups (irrespective of isolated or not AVR) found a survival benefit for mechanical.4Diaz R. Hernandez-Vaquero D. Alvarez-Cabo R. Avanzas P. Silva J. Moris C. et al.Long-term outcomes of mechanical versus biological aortic valve prosthesis: systematic review and meta-analysis.J Thorac Cardiovasc Surg. 2019; 158: 706-714.e18Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar Bioprostheses are associated with more reintervention, and patients who underwent CABG during the first surgery have a higher operative risk during the reintervention. Therefore, we should be careful when comparing outcomes from studies with isolated AVR and AVR with concomitant CABG; furthermore, meta-analyses studying this association should include meta-regression with concomitant CABG as a moderator before reaching any conclusion. The authors present an interesting hypothesis centered on the improvement of bioprosthesis quality as an explanation to the lower reintervention rates in patients with bioprostheses during 2 different time periods (2000-2008 and 2009-2018). Although the improvement in the quality of bioprostheses is undeniable, there are 2 main limitations to this conclusion: (1) Reintervention is a “too late” parameter to be used as an indicator for prosthesis durability; and (2) comparing reintervention in patients with a bioprosthesis between 2 groups with different time periods carries an implicit risk of bias. Duration of follow-up and therefore time for prosthesis degeneration requiring reintervention will be longer in the 2000-2008 group. The main take-home message is that bioprostheses are an excellent option for young patients (aged 50-65 years) who undergo isolated AVR. Although reintervention is higher than in those with mechanical AVR, mortality associated with re-do isolated AVR is not reflected in long-term survival. Biological versus mechanical prostheses for aortic valve replacementThe Journal of Thoracic and Cardiovascular SurgeryVol. 165Issue 2PreviewLong-term real-world outcomes are critical for informing decisions about biological (Bio) or mechanical (Mech) prostheses for aortic valve replacement, particularly in patients aged between 50 and 65 years. The objective was to compare long-term survival and major adverse cardiac and cardiovascular events (ie, stroke, reoperation, and major bleeding) within this population. Full-Text PDF" @default.
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• W3133026298 date "2023-02-01" @default.
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• W3133026298 title "Commentary: It's better to be alone than in bad company…at least for bioprosthesis" @default.
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• W3133026298 doi "https://doi.org/10.1016/j.jtcvs.2021.02.048" @default.
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