Structural and Non-Structural Deterioration After Biological Aortic Valve Replacement: Long-Term Outcomes of 918 High-Risk Patients.

introductionThe global disease burden of aortic valve disease is already substantial and is projected to rise significantly in the coming decades. Aortic valve replacement (AVR) with a biological prosthesis has become highly popular and commonly used. This study aims to assess long-term outcomes after biological AVR with regard to structural and non-structural deterioration.

methodsIn this single-centre retrospective study, 918 patients undergoing surgical AVR with a biological prosthesis at the University Hospital Frankfurt from January 2006 to July 2009 were included. The primary endpoints were freedom from reoperation and from structural and non-structural deterioration, and the secondary was long-term survival. Follow-up was completed in 95.6% with a median of 7.6 years, accounting 6610 patient-years. The mean age was 74.9 years and a median EuroSCORE II (range) was 3.34 (0.77-62.4). Twenty-two percent of surgeries were either emergent or urgent. Many patients had concomitant surgery, while coronary artery bypass grafting in 45.3% of patients was the most common. Three prosthetic valve models were used in our patient population: Carpentier Edwards Perimount (CEP) Model 2900, Model 3000 and Medtronic Mosaic (MM).

resultsReoperation occurred in 36 patients (3.9%) due to endocarditis (2.0%), aortic root aneurysm (0.1%), isolated or combined aortic stenosis or aortic regurgitation (1.9%). Freedom from reoperation at 5, 10 and 15 years was 97 ± 0.6%, 95.6 ± 0.8% and 90.3 ± 2.3%, respectively. Freedom from major stroke at 5, 10 and 15 years was 97.9 ± 0.0%, 96.4 ± 0.8%, and 96.1 ± 0.08%, and freedom from major bleeding event at 5, 10 and 15 years was 98.5 ± 0.4%, 95.7 ± 0.9% and 92.7 ± 2.2%, respectively. A subgroup analysis of the Carpentier Edwards (CEP) valves and the Medtronic Mosaic (MM) valves showed no significant differences regarding the primary endpoints. The overall survival at 5, 10 and 15 years was 67 ± 1.7%, 39.8 ± 1.8%, and 15.1 ± 2.2% respectively. The Kaplan-Meier survival estimator was 96 ± 2.2 months.

conclusionThis study showed a good long-term survival of surgical AVR with biological prostheses in relatively high-risk and elderly patient population. All biological prosthetic valves showed good long-term durability with low levels of complications and reoperations. The different models did not show any significant differences. Surgical AVR remains a valuable therapeutic option even though transcatheter aortic valve implantation has been greatly expanded since its introduction.