Abstract 5845: Are Aortic Bioprostheses an Increasingly Good Option in Selected Patients Below the Age of 65?
To characterize contemporary long-term results of AVR as a function of type of prosthesis and subsequent competing risks. 5470 consecutive patients had AVR ± CABG at 3 centers between 1993–2006. Microsimulation survival models were developed combining perioperative mortality estimates from multivariable modeling of individual patient data, UK survival and random effects meta-analyses of valve-related events. Outputs were predicted and event-free life expectancy, and lifetime event rates according to patient characteristics of age, sex, creatinine, valve type, and concomitant CABG. In multivariable analysis long-term survival was significantly influenced by age (hazard ratio, HR, 1.52 per 10-year increment), male sex (HR 1.20), bioprosthesis (HR 1.25) and pre-operative creatinine, but not by concomitant CABG. Recipients of bioprostheses had longer average life expectancy for implant ages from 59 onwards in both men (see figure⇓) and women. The improvement in event-free survival for mechanical prostheses was greater at younger ages (3.4 years for implant age 50) and extended to implant age 65. Concomitant CABG increased operative mortality but conferred only slightly shorter life expectancy and event-free life expectancy than for those having AVR alone. Creatinine also had only a small absolute effect on outcomes. Structural bioprosthetic valve degeneration was the most common long-term complication. Predictions from simulation models were in excellent agreement with UK Heart Valve Registry survival data. Aortic bioprostheses could be implanted in many UK patients aged 59–65 without significant long-term hazards.