• J. Thorac. Cardiovasc. Surg. · Nov 2017

    Long-term follow-up of bioprosthetic aortic valve replacement in patients aged ≤60 years.

    • Amedeo Anselmi, Erwan Flecher, Celine Chabanne, Vito Giovanni Ruggieri, Thierry Langanay, Hervé Corbineau, Alain Leguerrier, and Jean-Philippe Verhoye.
    • Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France. Electronic address: amedeo.anselmi@alice.it.
    • J. Thorac. Cardiovasc. Surg. 2017 Nov 1; 154 (5): 1534-1541.e4.

    ObjectiveTo address the long-term durability of bioprostheses used for aortic valve replacement (AVR) in adult patients aged ≤60 years at the time of surgery.MethodsThrough a retrospective review of a prospectively collected database, we identified 416 bioprosthetic AVRs performed between 1977 and 2013. A prospective follow-up of valve-related and non-valve-related events was performed.ResultsFollow-up was 98.5% complete (2423.1 patient-years; average, 6 ± 5.5 years). At 15 years, overall survival was 62.1 ± 4.4%; freedom from valve-related death was 97.1 ± 1.6%. There were 68 SVD events (11.9 ± 28.8 years after surgery). Freedom from SVD at 15 years was 48.7 ± 5.5% for Kaplan-Meier analysis and 61.4 ± 4.3% for competing-risks analysis. After stratification into age subgroups (<40 years, ≥40 and <50 years, and ≥50 and ≤60 years), we observed no significant difference in freedom from SVD (P = .50). The average delay to SVD was not statistically different among subgroups (P = .30). There were 57 reoperations for SVD (11.8 ± 5.2 years after implantation). The 15 year freedom from reoperation for SVD was 55.4 ± 5.6% by Kaplan-Meier analysis and 67.1 ± 4.2% by competing-risks analysis. After stratification by age, freedom from reoperation for SVD was comparable (P = .13). Freedom from any valve-related complication or death was 42 ± 5% by Kaplan-Meier analysis and 54.4 ± 4.1% by competing-risks analysis.ConclusionsThe lifetime risk of SVD is considerable in patients aged ≤60 years at the time of bioprosthesis implantation. Nonetheless, durability remains consistent during the first decade; additional data are required for the second decade. Patients' information is pivotal for valve choice (competing-risks method).Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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