Bioprosthetic vs. Mechanical Aortic Valve Replacement in Patients Aged 40-75
JACC 25 January 2025.
Bioprosthetic vs. Mechanical Aortic Valve Replacement in Patients Aged 40-75
New research, presented at the Society of Thoracic Surgeons (STS) 2025 meeting and published in The Journal of the American College of Cardiology, demonstrates that mechanical aortic valves provide significantly better long-term survival compared to bioprosthetic valves for patients aged 60 or younger undergoing surgical aortic valve replacement (SAVR).
The study analyzed data from 109,842 patients aged 40 to 75 who underwent SAVR between 2008 and 2019, using the Society of Thoracic Surgeons Adult Cardiac Surgery Database and the National Death Index. Among the participants, 86% received bioprosthetic valves, while 14% received mechanical valves. Patients receiving mechanical valves were generally younger and presented with more severe aortic insufficiency but fewer comorbidities like hypertension.
Key findings include:
• Survival Advantage: Mechanical valves were associated with lower all-cause mortality, with the most pronounced benefit observed in patients aged 60 or younger.
• Decline in Mechanical Valve Use: Over 12 years, the proportion of SAVR patients receiving mechanical valves declined from 20% to 10%, reflecting a growing preference for bioprosthetic valves, particularly with the rise of TAVR procedures.
The authors emphasize that current trends favoring bioprosthetic valves for younger patients are not backed by randomized trials or long-term national data. Instead, mechanical valves may offer superior lifetime management by reducing the need for reoperation and optimizing survival. This study challenges clinicians to reconsider treatment strategies, particularly for patients aged 60 or younger.
This research underscores the need for individualized patient care, but it highlights the survival advantage of mechanical valves, urging surgeons and cardiologists to reevaluate current practices.
