Influence of Prosthesis Type on Long-Term Survival after Re-replacement of Aortic Valve Prosthesis

Abstract

<p><b>Background:</b> The purpose of this study is to examine the influence of the prosthesis type on early mortality and long-term survival after re-replacement of aortic valve prosthesis, especially in patients over 60 years old.</p><p><b>Methods:</b> Late outcome of 223 patients who underwent a reoperation on the aortic valve and received a mechanical (mechanical group) or biological (biological group) heart valve prosthesis at a single institution were analyzed for survival and major valve-related complications, including structural valve deterioration, thromboembolism, hemorrhage, further reoperation, and valve-related mortality.</p><p><b>Results:</b> Preoperative New York Heart Association class IV (<i>P</i> = 0.001), emergency procedure (<i>P</i> = 0.002), and endocarditis (<i>P</i> = 0.025) were significant risk factors for 30-day mortality rates, which were 8.4 % and 12.5 %, respectively (mechanical versus biological group, <i>P</i> = 0.361). A subanalysis of elective patients revealed a low risk of 30-day mortality of 2.4 % and 1.8 %, respectively. Event-free survival was comparable at 5 years (73.9% � 3.6% versus 70.5% � 6.5%, mechanical versus biological group) and 10 year (49.7% � 5.0% versus 35.3% � 9.8%, mechanical versus biological group). In a propensity-matched subanalysis, survival and event-free survival were comparable at 5 and 10 years in both groups.</p><p><b>Conclusion:</b> The type of aortic valve prosthesis did not affect early outcome and late survival in patients who underwent valve replacement, and therefore, the current strategy favoring a biological aortic valve prosthesis for patients aged over 60 years in first-time operations could also be applied in re-replacement.</p>