Propensity matched long-term analysis of mechanical versus stentless aortic valve replacement in the younger patient
Abstract OBJECTIVES The choice of prosthesis for aortic valve replacement (AVR) in younger patients remains controversial. Stentless AVR was introduced 3 decades ago, with the aim of better haemodynamics and durability than stented xenografts. The objective of this analysis was to compare the long...
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| Veröffentlicht in: | European journal of cardio-thoracic surgery 2021-07, Vol.60 (2), p.276-283 |
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| creator | Christ, Torsten Borck, Robin Dushe, Simon Sündermann, Simon Harald Falk, Volkmar Grubitzsch, Herko |
| description | Abstract
OBJECTIVES
The choice of prosthesis for aortic valve replacement (AVR) in younger patients remains controversial. Stentless AVR was introduced 3 decades ago, with the aim of better haemodynamics and durability than stented xenografts. The objective of this analysis was to compare the long-term outcomes to mechanical prostheses in younger patients (age ≤60 years).
METHODS
All adult patients who underwent AVR due to aortic valve stenosis and/or insufficiency between 1993 and 2002 were identified. After the exclusion of patients with congenital heart defects, aortic dissections and Ross-procedures, 158 patients with stentless valves and 226 patients with bi-leaflet mechanical valves were finally included in this analysis. Sixty-six patient pairs could be included in a propensity matched analysis. Mortality and morbidity including stroke, bleeding, endocarditis and reoperation were analysed.
RESULTS
Group baseline characteristics and operative data did not differ significantly after propensity matching. Hospital mortality was 0.0% in the stentless and 1.5% in the mechanical group. Total patient years/median follow-up was 2029.1/15.4 years (completeness: 100.0%, range: 0–25 years). After 20 years, actuarial survival was 47.0 ± 6.4% in the stentless and 53.3 ± 6.6% in mechanical group (P = 0.69). Bleeding, endocarditis and stroke occurred rarely and did not differ significantly between groups. After 20 years, actuarial overall freedom-from-reoperation was 45.1 ± 8.2% in the stentless group and 90.4 ± 4.1% in the mechanical group (P |
| doi_str_mv | 10.1093/ejcts/ezab090 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_webof</sourceid><recordid>TN_cdi_proquest_miscellaneous_2500372458</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/ejcts/ezab090</oup_id><sourcerecordid>2500372458</sourcerecordid><originalsourceid>FETCH-LOGICAL-c365t-27b646132f7c69b6f9aaed85aae11e8484c920d38e661ad7fa4f6296dce755eb3</originalsourceid><addsrcrecordid>eNqNkU1r3DAQhkVJaD7aY69Fx0BxI1m2ZB_L0iaFQHNIoTcjy-Osgiy5GnnL9tdHm92kx-aiGaSH4Z1HhHzg7DNnrbiEB5PwEv7qnrXsDTnljRKFEtWvo9wzzgrVVuyEnCE-MMakKNVbciKEbIWs5SlJtzHM4NGmLZ10MmsYqAv-vkgQJ6q9dlu0SMNIJzBr7a3Rjm4g4oIUE_jkAJHqEJM1dKPdBmiE2WkDU36k1tO0BroNi7-HSGedbL5-R45H7RDeH-o5-fnt693qurj5cfV99eWmMDlcKkrVy0pyUY7KyLaXY6s1DE2dT86hqZrKtCUbRANScj2oUVejLFs5GFB1Db04Jxf7uXMMvxfA1E0WDTinPYQFu7JmTKiyqpuMFnvUxIAYYezmaCcdtx1n3U509yS6O4jO_MfD6KWfYHihn81m4NMe-AN9GNHkvQ28YPkrlCgl3yVgXGS6eT29sil7DH6VraZ_S4Zl_k_oR7BRrSg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2500372458</pqid></control><display><type>article</type><title>Propensity matched long-term analysis of mechanical versus stentless aortic valve replacement in the younger patient</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Christ, Torsten ; Borck, Robin ; Dushe, Simon ; Sündermann, Simon Harald ; Falk, Volkmar ; Grubitzsch, Herko</creator><creatorcontrib>Christ, Torsten ; Borck, Robin ; Dushe, Simon ; Sündermann, Simon Harald ; Falk, Volkmar ; Grubitzsch, Herko</creatorcontrib><description>Abstract
OBJECTIVES
The choice of prosthesis for aortic valve replacement (AVR) in younger patients remains controversial. Stentless AVR was introduced 3 decades ago, with the aim of better haemodynamics and durability than stented xenografts. The objective of this analysis was to compare the long-term outcomes to mechanical prostheses in younger patients (age ≤60 years).
METHODS
All adult patients who underwent AVR due to aortic valve stenosis and/or insufficiency between 1993 and 2002 were identified. After the exclusion of patients with congenital heart defects, aortic dissections and Ross-procedures, 158 patients with stentless valves and 226 patients with bi-leaflet mechanical valves were finally included in this analysis. Sixty-six patient pairs could be included in a propensity matched analysis. Mortality and morbidity including stroke, bleeding, endocarditis and reoperation were analysed.
RESULTS
Group baseline characteristics and operative data did not differ significantly after propensity matching. Hospital mortality was 0.0% in the stentless and 1.5% in the mechanical group. Total patient years/median follow-up was 2029.1/15.4 years (completeness: 100.0%, range: 0–25 years). After 20 years, actuarial survival was 47.0 ± 6.4% in the stentless and 53.3 ± 6.6% in mechanical group (P = 0.69). Bleeding, endocarditis and stroke occurred rarely and did not differ significantly between groups. After 20 years, actuarial overall freedom-from-reoperation was 45.1 ± 8.2% in the stentless group and 90.4 ± 4.1% in the mechanical group (P < 0.001). Hospital mortality while reoperation was 7.4% in the stentless group and 0% in the mechanical group (P = 1.0)
CONCLUSIONS
Long-term morbidity and mortality of stentless and mechanical aortic valves were statistically not different besides a significantly higher reoperation rate after stentless AVR combined with a probably higher risk of in-hospital mortality. Thus, mechanical AVR should remain the procedure of choice in younger patients.</description><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1093/ejcts/ezab090</identifier><identifier>PMID: 33693656</identifier><language>eng</language><publisher>CARY: Oxford University Press</publisher><subject>Adult ; Aortic Valve - surgery ; Aortic Valve Stenosis - surgery ; Bioprosthesis ; Cardiac & Cardiovascular Systems ; Cardiovascular System & Cardiology ; Heart Valve Prosthesis ; Humans ; Life Sciences & Biomedicine ; Middle Aged ; Prosthesis Design ; Respiratory System ; Science & Technology ; Surgery</subject><ispartof>European journal of cardio-thoracic surgery, 2021-07, Vol.60 (2), p.276-283</ispartof><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2021</rights><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>6</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000732612500013</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c365t-27b646132f7c69b6f9aaed85aae11e8484c920d38e661ad7fa4f6296dce755eb3</citedby><cites>FETCH-LOGICAL-c365t-27b646132f7c69b6f9aaed85aae11e8484c920d38e661ad7fa4f6296dce755eb3</cites><orcidid>0000-0002-7911-8620 ; 0000-0001-5925-4070 ; 0000-0001-9135-6827 ; 0000-0001-8060-8507</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33693656$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Christ, Torsten</creatorcontrib><creatorcontrib>Borck, Robin</creatorcontrib><creatorcontrib>Dushe, Simon</creatorcontrib><creatorcontrib>Sündermann, Simon Harald</creatorcontrib><creatorcontrib>Falk, Volkmar</creatorcontrib><creatorcontrib>Grubitzsch, Herko</creatorcontrib><title>Propensity matched long-term analysis of mechanical versus stentless aortic valve replacement in the younger patient</title><title>European journal of cardio-thoracic surgery</title><addtitle>EUR J CARDIO-THORAC</addtitle><addtitle>Eur J Cardiothorac Surg</addtitle><description>Abstract
OBJECTIVES
The choice of prosthesis for aortic valve replacement (AVR) in younger patients remains controversial. Stentless AVR was introduced 3 decades ago, with the aim of better haemodynamics and durability than stented xenografts. The objective of this analysis was to compare the long-term outcomes to mechanical prostheses in younger patients (age ≤60 years).
METHODS
All adult patients who underwent AVR due to aortic valve stenosis and/or insufficiency between 1993 and 2002 were identified. After the exclusion of patients with congenital heart defects, aortic dissections and Ross-procedures, 158 patients with stentless valves and 226 patients with bi-leaflet mechanical valves were finally included in this analysis. Sixty-six patient pairs could be included in a propensity matched analysis. Mortality and morbidity including stroke, bleeding, endocarditis and reoperation were analysed.
RESULTS
Group baseline characteristics and operative data did not differ significantly after propensity matching. Hospital mortality was 0.0% in the stentless and 1.5% in the mechanical group. Total patient years/median follow-up was 2029.1/15.4 years (completeness: 100.0%, range: 0–25 years). After 20 years, actuarial survival was 47.0 ± 6.4% in the stentless and 53.3 ± 6.6% in mechanical group (P = 0.69). Bleeding, endocarditis and stroke occurred rarely and did not differ significantly between groups. After 20 years, actuarial overall freedom-from-reoperation was 45.1 ± 8.2% in the stentless group and 90.4 ± 4.1% in the mechanical group (P < 0.001). Hospital mortality while reoperation was 7.4% in the stentless group and 0% in the mechanical group (P = 1.0)
CONCLUSIONS
Long-term morbidity and mortality of stentless and mechanical aortic valves were statistically not different besides a significantly higher reoperation rate after stentless AVR combined with a probably higher risk of in-hospital mortality. Thus, mechanical AVR should remain the procedure of choice in younger patients.</description><subject>Adult</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Bioprosthesis</subject><subject>Cardiac & Cardiovascular Systems</subject><subject>Cardiovascular System & Cardiology</subject><subject>Heart Valve Prosthesis</subject><subject>Humans</subject><subject>Life Sciences & Biomedicine</subject><subject>Middle Aged</subject><subject>Prosthesis Design</subject><subject>Respiratory System</subject><subject>Science & Technology</subject><subject>Surgery</subject><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>HGBXW</sourceid><sourceid>EIF</sourceid><recordid>eNqNkU1r3DAQhkVJaD7aY69Fx0BxI1m2ZB_L0iaFQHNIoTcjy-Osgiy5GnnL9tdHm92kx-aiGaSH4Z1HhHzg7DNnrbiEB5PwEv7qnrXsDTnljRKFEtWvo9wzzgrVVuyEnCE-MMakKNVbciKEbIWs5SlJtzHM4NGmLZ10MmsYqAv-vkgQJ6q9dlu0SMNIJzBr7a3Rjm4g4oIUE_jkAJHqEJM1dKPdBmiE2WkDU36k1tO0BroNi7-HSGedbL5-R45H7RDeH-o5-fnt693qurj5cfV99eWmMDlcKkrVy0pyUY7KyLaXY6s1DE2dT86hqZrKtCUbRANScj2oUVejLFs5GFB1Db04Jxf7uXMMvxfA1E0WDTinPYQFu7JmTKiyqpuMFnvUxIAYYezmaCcdtx1n3U509yS6O4jO_MfD6KWfYHihn81m4NMe-AN9GNHkvQ28YPkrlCgl3yVgXGS6eT29sil7DH6VraZ_S4Zl_k_oR7BRrSg</recordid><startdate>20210730</startdate><enddate>20210730</enddate><creator>Christ, Torsten</creator><creator>Borck, Robin</creator><creator>Dushe, Simon</creator><creator>Sündermann, Simon Harald</creator><creator>Falk, Volkmar</creator><creator>Grubitzsch, Herko</creator><general>Oxford University Press</general><general>Oxford Univ Press</general><scope>BLEPL</scope><scope>DTL</scope><scope>HGBXW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7911-8620</orcidid><orcidid>https://orcid.org/0000-0001-5925-4070</orcidid><orcidid>https://orcid.org/0000-0001-9135-6827</orcidid><orcidid>https://orcid.org/0000-0001-8060-8507</orcidid></search><sort><creationdate>20210730</creationdate><title>Propensity matched long-term analysis of mechanical versus stentless aortic valve replacement in the younger patient</title><author>Christ, Torsten ; Borck, Robin ; Dushe, Simon ; Sündermann, Simon Harald ; Falk, Volkmar ; Grubitzsch, Herko</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-27b646132f7c69b6f9aaed85aae11e8484c920d38e661ad7fa4f6296dce755eb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Aortic Valve - surgery</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Bioprosthesis</topic><topic>Cardiac & Cardiovascular Systems</topic><topic>Cardiovascular System & Cardiology</topic><topic>Heart Valve Prosthesis</topic><topic>Humans</topic><topic>Life Sciences & Biomedicine</topic><topic>Middle Aged</topic><topic>Prosthesis Design</topic><topic>Respiratory System</topic><topic>Science & Technology</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Christ, Torsten</creatorcontrib><creatorcontrib>Borck, Robin</creatorcontrib><creatorcontrib>Dushe, Simon</creatorcontrib><creatorcontrib>Sündermann, Simon Harald</creatorcontrib><creatorcontrib>Falk, Volkmar</creatorcontrib><creatorcontrib>Grubitzsch, Herko</creatorcontrib><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Web of Science - Science Citation Index Expanded - 2021</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Christ, Torsten</au><au>Borck, Robin</au><au>Dushe, Simon</au><au>Sündermann, Simon Harald</au><au>Falk, Volkmar</au><au>Grubitzsch, Herko</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Propensity matched long-term analysis of mechanical versus stentless aortic valve replacement in the younger patient</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><stitle>EUR J CARDIO-THORAC</stitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>2021-07-30</date><risdate>2021</risdate><volume>60</volume><issue>2</issue><spage>276</spage><epage>283</epage><pages>276-283</pages><issn>1010-7940</issn><eissn>1873-734X</eissn><abstract>Abstract
OBJECTIVES
The choice of prosthesis for aortic valve replacement (AVR) in younger patients remains controversial. Stentless AVR was introduced 3 decades ago, with the aim of better haemodynamics and durability than stented xenografts. The objective of this analysis was to compare the long-term outcomes to mechanical prostheses in younger patients (age ≤60 years).
METHODS
All adult patients who underwent AVR due to aortic valve stenosis and/or insufficiency between 1993 and 2002 were identified. After the exclusion of patients with congenital heart defects, aortic dissections and Ross-procedures, 158 patients with stentless valves and 226 patients with bi-leaflet mechanical valves were finally included in this analysis. Sixty-six patient pairs could be included in a propensity matched analysis. Mortality and morbidity including stroke, bleeding, endocarditis and reoperation were analysed.
RESULTS
Group baseline characteristics and operative data did not differ significantly after propensity matching. Hospital mortality was 0.0% in the stentless and 1.5% in the mechanical group. Total patient years/median follow-up was 2029.1/15.4 years (completeness: 100.0%, range: 0–25 years). After 20 years, actuarial survival was 47.0 ± 6.4% in the stentless and 53.3 ± 6.6% in mechanical group (P = 0.69). Bleeding, endocarditis and stroke occurred rarely and did not differ significantly between groups. After 20 years, actuarial overall freedom-from-reoperation was 45.1 ± 8.2% in the stentless group and 90.4 ± 4.1% in the mechanical group (P < 0.001). Hospital mortality while reoperation was 7.4% in the stentless group and 0% in the mechanical group (P = 1.0)
CONCLUSIONS
Long-term morbidity and mortality of stentless and mechanical aortic valves were statistically not different besides a significantly higher reoperation rate after stentless AVR combined with a probably higher risk of in-hospital mortality. Thus, mechanical AVR should remain the procedure of choice in younger patients.</abstract><cop>CARY</cop><pub>Oxford University Press</pub><pmid>33693656</pmid><doi>10.1093/ejcts/ezab090</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-7911-8620</orcidid><orcidid>https://orcid.org/0000-0001-5925-4070</orcidid><orcidid>https://orcid.org/0000-0001-9135-6827</orcidid><orcidid>https://orcid.org/0000-0001-8060-8507</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Aortic Valve - surgery Aortic Valve Stenosis - surgery Bioprosthesis Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Heart Valve Prosthesis Humans Life Sciences & Biomedicine Middle Aged Prosthesis Design Respiratory System Science & Technology Surgery |
| title | Propensity matched long-term analysis of mechanical versus stentless aortic valve replacement in the younger patient |
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