Surgical Aortic Valve Replacement in Patients Aged 50 to 69 Years: Insights from the German Aortic Valve Registry (GARY)

Background: The aim of this study was to analyze the outcome of patients between 50 and 69 years of age undergoing biological or mechanical aortic valve replacement.

Method: Data were collected from the German Aortic Valve Registry (GARY). A total 3,046 patients undergoing isolated SAVR between 2011 and 2012 were investigated and a propensity score matching was performed. Data were analyzed regarding baseline characteristics and outcome parameters such as 5-year survival, stroke, and reintervention.

Results: Within this period, 2,239 patients received a biological prosthesis (bio-SAVR), while 807 patients received a mechanical prosthesis (mech-SAVR). Mean age in the bio-SAVR group was 64 (60–67) and 57 (53–61) in the mech-SAVR group (p < 0.001). In the overall cohort, there were more female patients in the bio-SAVR group (32.7 vs. 28.4%, p = 0.02) and log EuroSCORE was higher (3.2 vs. 2.3%, p < 0.001). After propensity matching (545 pairs), there was no difference in the mortality at 5-year follow-up (FU) (8.3% bio-SAVR vs. 7.2% mech-SAVR, p = 0.45) nor for reoperation/reintervention (4.6% bio-SAVR vs. 2.9% mech-SAVR, p = 0.22). Patients undergoing mech-AVR suffered from a higher stroke rate (1.5 vs. 0.4% [p = 0.06] at discharge; 2.4 vs. 0.7% at 1-year FU; 4.5 vs. 1.0% 3-year FU and 5.3 vs. 2.4% at 5-year FU).

Conclusion: AVR with biological or mechanical prosthesis showed similar 5-year outcomes for survival and reoperation in a propensity matched cohort. Regarding the increased stroke rate after mechanical AVR after a follow-up period of 5 years, the choice of a mechanical valve in younger patients should be made more carefully.

Publication History

Article published online:
03 February 2022