Durability of Bioprosthetic Aortic Valves: Structural Deterioration and Incidence of Events at Long-Term Follow-Up

pp. 271-277

Abstract

Background: In the treatment of severe aortic stenosis there has been a shift in the choice of the valve prosthesis type toward the use of biological valves. At present, bioprosthetic valves are used in 80% of aortic valve replacements worldwide. Their main limitation is their reduced long-term durability. No assessment has been yet performed in our setting regarding the durability of bioprosthetic valves and the incidence of long-term events.

Objectives: To evaluate the long-term performance of bioprosthetic aortic valves related to survival and echocardiographic incidence of structural valve deterioration (SVD).
Methods: A retrospective study of 2365 patients undergoing aortic valve replacement with biological prosthesis between January 2003 and December 2023. We analyzed the long-term survival and the incidence of SVD pursuant to changes in the mean transprosthetic gradient (mTPG) according to age (< or ≥60 years) and prosthetic valve size (< or ≥ 23 mm).

Results: Mean age was 73±3.05 years (105 patients <60 years and 2530 patients ≥60 years). A total of 63.4% was male. Of patients, 92% completed a long-term follow-up, mean 5.9±3.2 years. Survival at 5 and 10 years according to age was: in patients <60 years: 98.3 and 91.7% vs. patients ≥60 years: 81.7 and 65.7% (p=0.007), respectively. A total of 1399 (59.7%) patients had an overall echocardiographic follow-up. The values of mTPG at baseline, 5 and 10 years were: a) according to age: in patients <60 years: 16±3 mmHg, 16±6 mmHg and 19±5 mmHg, vs. in patients ≥60 years: 15±5 mmHg, 16±7 mmHg and 18±7 mmHg (p=NS); b) according to prosthesis size: <23 mm: 17±6 mmHg, 19±7mmHg and 22±7 mmHg, vs. ≥23 mm:
15±5 mmHg, 16±6 mmHg and 18±6 mmHg (p= 0.001).

Conclusions: Patients with bioprosthetic valves experienced high long-term survival with some differences according to age group. At follow-up, differences in mTPG (<10 mmHg) were observed in prosthetic valve sizes <23 mm, showing low incidence of severe SVD.

How to cite this article:

Navia D, Espinoza J, Piccinini F, Vrancic M, Castro F, Aranda A, et al. Durability of Bioprosthetic Aortic Valves: Structural Deterioration and Incidence of Events at Long-Term Follow-Up. Rev Argent Cardiol 2024;92:271-277. http://dx.doi.org/10.7775/rac.v92.i4.20794