Mechanical Valve Procedure May Worsen Long-term Outcomes

Patients younger than 55 years who undergo mechanical aortic valve replacement (AVR) have higher risks for mortality and valve-related events, according to a recent review.

For their systematic review, the researchers identified 29 studies about clinical outcomes following AVR, which included 5728 patients aged 18 to 55 years. The pooled mean age at surgery was 48 years. The researchers estimated the life expectancy and calculated the pooled lifetime risk for valve-related events following surgery.
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Overall, 38.7% of late deaths were due to the implanted valve.

The model estimated that the pooled early mortality risk was 3.15% and late mortality rate risk was 1.55% per year post-surgery. The pooled thromboembolism rate was 0.9% per year, major bleeding was 0.85% per year, nonstructural valve dysfunction was 0.39% per year, and reintervention was 0.51% per year, which was predominately due to nonstructural valve dysfunction and endocarditis. However, structural valve deterioration was not observed.

According to the authors, these risks would mean that a 45-year-old patient who underwent mechanical AVR would have an estimated live expectancy without any adverse events of 19 years. In addition, the patient would have an 18% lifetime risk of thromboembolism, 15% lifetime risk for bleeding, and 10% lifetime risk for reintervention.

“This study demonstrates that outcome[s] after mechanical AVR in non-elderly adults is characterized by suboptimal survival and considerable lifetime risk of anticoagulation-related complications, but also reoperation,” the researchers concluded.

“Non-elderly adult patients who are facing prosthetic valve selection are entitled to conveyance of evidence-based estimates of the risks and benefits of both mechanical and biological valve options in a shared decision-making process.”

—Melissa Weiss

Reference:

Korteland NM, Etnel JRG, Arabkhani B, et al. Mechanical aortic valve replacement in non-elderly adults: meta-analysis and microsimulation. Euro Heart J. 2017; 38(45): 3370-3377. https://doi.org/10.1093/eurheartj/ehx199.