The Choice of Surgical Aortic Valve Replacement Type and Mid-Term Outcomes in 50 to 65-Year-Olds: Results of the AUTHEARTVISIT Study

In recent years, there has been a trend toward using more bioprosthetic valves compared to mechanical valves in patients under 65 years old. This study evaluated Austrian patients undergoing isolated surgical aortic valve replacement over a 10-year period and compared the outcomes of 1,018 patients receiving mechanical valves to 2,743 receiving a bioprosthetic valves, specifically in patients aged 50 to 65 years. The authors found that the biologic group had significantly higher risks of major adverse cardiac events, reoperation rates, and worsened overall survival compared to the mechanical valve group, which remained true even after propensity matching. Interestingly, stroke and bleeding risks were similar between the groups, which contrasts with reports from other studies. While 92.7 percent of mechanical valve patients received direct thrombin inhibitors, FXa inhibitors, or Vitamin K antagonists, 52.3 percent of bioprosthetic valve patients also received these medications. The authors suggest that careful consideration of the risks vs benefits of aortic valve choice, especially in younger patients, is warranted in light of their findings.