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Long-term outcomes of patients undergoing mechanical versus bioprosthetic aortic root replacement
James Brown, Derek Serna-Gallegos, Forozan Navid, Yisi Wang, Jacqueline Ridgley, Pyongsoo David Yoon, David Kaczorowski, Danny Chu, Ibrahim Sultan.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Objective: To determine the impact of bioprosthetic vs. mechanical valves on survival after aortic root replacement (ARR).Methods: This was an observational study of consecutive cardiac surgeries from 2010 and 2018. Patients with ARR were identified via a prospectively maintained institutional database, with endocarditis being excluded. Kaplan-Meier survival estimation and multivariable Cox regression were performed.Results: Excluding endocarditis, 701 patients underwent complete ARR. 455 (64.9%) received a bioprosthetic valve, while 246 (35.1%) received a mechanical valve, with a median follow-up of 4.06 years (2.36, 5.80). Patients receiving bioprosthetic valves were older and more likely to be female, but the groups were otherwise similar across baseline comorbidities (p>0.05). There were more concomitant CABG and non-aortic valve operations in the bioprosthetic group, but the proportion of aortic dissections, circulatory arrest, and perfusion and ischemic times were similar across each group (p>0.05). For the bioprosthetic group, operative mortality was higher (7.9% vs. 2.4%, p=0.004), hospital stay was longer (11.4 11.0 vs. 9.5 10.1, p<0.001) and prolonged ventilation >24 hours was more frequent (21.3% vs. 13.0%, p=0.007); however, postoperative outcomes were otherwise similar, including stroke, re-exploration for bleeding, and new dialysis requirement (p>0.05). Kaplan-Meier survival estimates were higher for the mechanical valve group (Figure). Upon risk adjustment with multivariable Cox regression, mechanical valves remained associated with improved long-term survival (OR 0.42, 95% CI: 0.23, 0.77, p=0.005). Bleeding complications and reoperation rates were similar long-term.Conclusions: Mechanical valves may confer a survival benefit after ARR, versus bioprosthetic valves. However, surgeon bias may explain these results.


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