Long-term clinical outcomes in patients aged 50 to 70 years old undergoing surgical aortic valve replacement in the United Kingdom.

Objective: In the last decade, there has been an increased use of biological prosthesis in patients aged 50 to 70 years old undergoing surgical aortic valve replacement (SAVR). The COVID-19 pandemic disrupted health care services, which may have affected this trend. This study aims to evaluate the trends in prosthesis use and long-term clinical outcomes in patients aged 50 to 70 years old who underwent SAVR before, during, and after the COVID-19 pandemic in the United Kingdom. Methods: This was a retrospective analysis of prospectively collected data in all patients aged 50 to 70 years who underwent first-time, elective/urgent isolated SAVR from January 2013 to April 2025. Results: A total of 11,010 patients underwent SAVR during the study period, with a median age of 63.4 years (first and third quartile: 58.6, 67.0 years), of whom 67% (n = 7359) were male. The use of biological prosthesis increased from 57.5% in 2013 to 71.3% in 2024. Patients who received a mechanical prosthesis when compared with a biological prosthesis had a lower all-cause mortality (hazard ratio, 1.22; 95% CI, 1.03-1.43; Conclusions: The use of biological prosthesis has increased incrementally since 2013 and persisted post-COVID-19 pandemic. Mechanical valves had a lower all-cause mortality, cumulative incidence of infective endocarditis, and need for repeat intervention. However, they were associated with a greater incidence of stroke and bleeding. The lifetime management of this group of patients remains complex, and long-term high-quality randomised controlled trials are required.