Objective:

Aortic valve replacement (AVR) is the standard of care for treatment of aortic valve stenosis (AS). In non-elderly adults’ mechanical valve prostheses are recommended due to limited durability of biological valve prostheses. The aim of the study was to evaluate the long-term outcome and quality of life after AVR in patients younger than 60 years and compare mechanical (mech-AVR) and biological prosthesis (bio-AVR).

Methods:

A total 721 consecutive patients younger than 60 years who received. AVR at our institution between January 2005 and December 2018 were included. Follow-up protocol included clinical interview using a structured questionnaire (e.g. SF-12 and echocardiographic follow-up). Primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) and secondary endpoints were survival, aortic valve reintervention and quality of life.

Results

Biological prosthesis was implanted in 560 (78%) patients, whereas a mechanical was used in 161 (22%) patients. Mean age at the time of index AVR surgery was significantly higher in the bio-AVR group compared to mech-AVR (p<0.001). Landmark analysis by using an adjusted cox-model until 5 years, showed that COPD (HR 2.17;95%-CI 1.23-3.85;p=0.008), dialysis (HR 4.21;95%-CI 1.97-9.00;p<0.001), EuroSCORE II (HR 1.10; 95%-CI 1.05-1.15;p<0.001) and endocarditis (HR 2.61; 95%-CI 1.55-4.38;p<0.001) had significant impact on MACCE events. After 5 years, endocarditis still had a significant impact on MACCE rate (p=0.027). Further, landmark analysis revealed no differences in MACCE rate between mech-AVR vs. bio-AVR until 5 years postoperatively (p=0.973). Beginning with 5 years postoperatively, bio-AVR had a significantly higher MACCE rate vs. mech-AVR (HR 0.09; 95%-CI 0.02-0.50; p=0.006). Survival was comparable in both study subgroups. Survival was influenced by concomitant coronary artery disease (HR 2.53;p<0.001), dialysis (HR 5.02; p<0.001), EuroSCORE II (HR 1.09;p<0.001) and endocarditis (HR 3.09;p<0.001). At follow-up, physical QoL was similar in both groups (p=0.195) but mental QoL was worse after bio-AVR vs. mech-AVR (p<0.001).

Conclusion

Tissue AVR in non-elderly adults is associated with significantly higher MACCE rate after 5 years postoperatively and results in worse mental QoL during long-term follow-up. The choice of aortic valve prosthesis does not impact the long-term survival. However, MACCE rate remains high at 10 years post-AVR in non-elderly adults, especially in the bio-AVR group.