A groundbreaking study conducted by the University of Bristol has unveiled that mechanical heart valves offer superior long-term survival rates compared to biological heart valves in patients aged 50 to 70 years. This extensive research analyzed data from 1,708 patients, with a median age of 63 and a predominance of male participants (61%). Of these patients, 1,191 individuals, accounting for 69.7%, received biological prostheses. Although short-term survival rates appeared similar for both types of heart valves, significant differences emerged over time.
Thirteen years post-surgery, patients with mechanical heart valves demonstrated markedly better survival rates than those with biological heart valves. The study highlights the enhanced long-term benefits of mechanical valves, particularly in cases involving smaller-sized valves. These findings resonate with a recent US study that reported superior 12-year survival rates for aortic mechanical valves compared to bioprosthetic valves in patients aged 60 or younger.
The past two decades have witnessed an increasing preference for biological over mechanical heart valve replacements. However, the new data provided by the University of Bristol study is "timely," according to Professor Enoch Akowuah, who emphasized the importance of determining if mechanical valves offer a better option for long-term survival in younger patient cohorts.
"The study is needed now because if this question about differences in survival between biological and mechanical valves is not answered, practice will change, with young patients having tissue valves (including TAVI), and the opportunity to determine if mechanical valves are in fact a better option for long-term survival in this younger patient cohort will be lost permanently," – Prof Enoch Akowuah
The study's results underscore the necessity of considering long-term prosthetic valve durability and avoiding the need for repeat procedures when evaluating valve surgery options for younger patients. It suggests that mechanical heart valves may present a more viable option for younger patients, especially those under 50 years of age. This aligns with current recommendations that emphasize a patient-centered and multifactorial approach when choosing between a mechanical prosthesis and a bioprosthesis.
According to Professor Akowuah, ignoring these findings could lead to significant mortality in younger patients over time due to changes in practice favoring tissue valves. The study's conclusions are consistent with the 2021 European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines on managing valvular heart disease.
"suggests that this change in practice may lead to significant mortality in these young patients over time," – Prof Enoch Akowuah
"urgently needed" to provide definitive evidence – Prof Enoch Akowuah
The study's findings have significant implications for managing valvular heart disease, particularly in younger patients. They highlight the importance of lifetime management strategies and the potential need for anticoagulation therapy in patients undergoing tissue aortic valve replacement. The results emphasize the critical role of mechanical valves in extending patient longevity and reducing the risks associated with multiple surgical interventions.
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