Bioprosthetic vs Mechanical Aortic Valves: Similar Safety, Different Complications

MedicalResearch.com Interview with:
Joanna Chikwe MD
Associate Professor
Department of Cardiovascular Surgery
Mount Sinai Medical Center and

Natalia N. Egorova, PhD
Department of Health Evidence and Policy,
Icahn School of Medicine at Mount Sinai
New York, New York

Medical Research: What are the main findings of the study?

Answer: This is one of the largest studies to date on the long-term outcomes of patients after aortic valve replacement. We found that bioprosthetic valves are as safe as mechanical valves in younger patients (age 50-69) – specifically, long-term death rates and stroke risk were very similar in patients who had either valve type. The main differences lay in the risk of other long-term complications: patients who had bioprosthetic valves were more likely to need repeat surgery in the long-term, whereas patients who had mechanical valves were more likely to experience a major bleeding event.

Medical Research: What was most surprising about the results?

Answer: We know that bioprosthetic valves are a very good option for older patients (age 70 or older). The reason we did the study is because the choice isn’t so clear cut in younger patients who are more likely to see bioprosthetic valve failure than older patients. We were surprised at how similar the survival curves were for patients that had each valve type – the curves are almost on top of each other. It really supports the view that the specific type of valve implanted has minimal impact on a patient’s life-expectancy.

Medical Research: What should clinicians and patients take away from your report?

Answer: The main take-away message is that when patients and clinicians are deciding between mechanical and bioprosthetic valves the differences they may want to focus on are the distant risk of future reoperation, versus the immediate risk and inconvenience of anticogulation. Patients who don’t want to face a life-time of anticoagulation, with daily medication, regular blood tests and lifestyle limitations, can safely opt for bioprosthetic valves. On the other hand, patients who are willing to accept the inconvenience of taking anticoagulation and really want to minimize their risk of distant reoperation will tend to favor mechanical valves, and this data shows that is also a reasonable choice.

Medical Research: What recommendations do you have for future research as a result of this study?

Answer: We will be publishing the findings of a study shortly which focuses on patients having mitral valve replacement – where the balance of risks is different to patients having aortic valve replacement. We are also looking at the best options for much younger patients having valve surgery. We hope that these studies will really enable patients and their clinicians to make the best decision for each individual by providing them with high quality evidence based on real-world clinical practice in patients of similar ages with similar problems.

Citation:

Chiang YP, Chikwe J, Moskowitz AJ, Itagaki S, Adams DH, Egorova NN. Survival and Long-term Outcomes Following Bioprosthetic vs Mechanical Aortic Valve Replacement in Patients Aged 50 to 69 Years. JAMA. 2014;312(13):1323-1329. doi:10.1001/jama.2014.12679.