Abstract 9364: Longevity of Heart Valve Bioprostheses According to the Age at Implantation: New Age-Specific Data for Clinical Decision-Making
Introduction: Evidence supporting the use of bioprostheses in young patients is steadily accumulating. We and others have shown that young patients who select a bioprosthesis at the time of initial valve replacement have an increased reoperation risk, but suffer no long-term survival detriment. However, the median durability of bioprostheses in younger adults, where accelerated structural failure may occur, remains poorly defined in the literature.
Hypothesis: We assessed the hypothesis that bioprostheses undergo accelerated degeneration when implanted in young patients.
Methods: We examined bioprosthesis durability in 4131 patients who underwent first-time bioprosthetic valve replacement in the aortic (AVR) (N=3157), mitral (MVR) (N=823), or in both the aortic and mitral positions (DVR) (N=151). All implants were performed after 1976. There were 937 patients below the age of 60 years at bioprosthesis implant (AVR 636, MVR 259, DVR 42).
Results: The median durability, with respect to reoperation from any cause, of isolated stented aortic bioprostheses was 11.2 years (95% confidence interval (CI) 10.1–12.4 years) for patients between 40 and 60 years of age, and 8.5 years (95% CI 7.3–10.3 years) for patients less than 40 years old at implantation. The median durability of isolated mitral bioprostheses was 11.3 years (95% CI 10.3–12.5 years) in patients between 40 and 60 years of age, and 9.5 years (95% CI 7.6–14.3 years) in patients less than 40 years old at implantation. The use of 2 bioprostheses in the context of DVR significantly increased reoperation risk (hazard ratio 1.9, 95% CI 1.2–2.8, p=0.004). The figure displays the freedom from reoperation according to age group and bioprosthesis implant site.
Conclusions: In conclusion, these data provide new age-specific prognostic information for young patients in need of heart valve replacement, who may want to know their expected time frame to reoperation if they choose a bioprosthesis.
- © 2010 by American Heart Association, Inc.