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      Trends in SAVR with biological vs. mechanical valves in middle-aged patients: results from a French large multi-centric survey

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          Abstract

          Background/introduction

          Currently, despite continued issues with durability ( 1), biological prosthetic valves are increasingly chosen over mechanical valves for surgical aortic valve replacement (SAVR) in adult patients of all ages, at least in Western countries. For younger patients, this choice means assuming the risks associated with a redo SAVR or valve-in-valve procedure.

          Purpose

          To assess the use of mechanical vs. biological valve prostheses for SAVR relative to patient's age and implant time in a large population extracted from the French National Database EPICARD.

          Methods

          Patients in EPICARD undergoing SAVR from 2007 to 2022 were included from 22 participating public or private centers chosen to represent a balanced representation of centre sizes and geographical discrepancies. Patients with associated pathology of the aorta (aneurysm or dissection) and requiring a vascular aortic prosthesis were excluded. Comparisons were made amongst centers, valve choice, implant date range, and patient age.

          Results

          We considered 101,070 valvular heart disease patients and included 72,375 SAVR (mean age 71.4 ± 12.2 years). We observed a mechanical vs. biological prosthesis ratio (MBPR) of 0.14 for the overall population. Before 50 years old (y-o), MBPR was >1.3 ( p < 0.001) while patients above 60 years-old received principally biological SAVR ( p < 0.0001). Concerning patients between 50 and 60 years-old patients, MPVR was 1.04 ( p = 0.03). Patients 50–60 years-old from the first and second study duration quartile (before August 2015) received preferentially mechanical SAVR ( p < 0.001). We observed a shift towards more biological SAVR ( p < 0.001) for patients from the third and fourth quartile to reach a MBPR at 0.43 during the last years of the series. Incidentally, simultaneous mitral valve replacement were more common in case of mechanical SAVR ( p < 0.0001), while associated CABGs were more frequent in case of biological SAVR ( p < 0.0001).

          Conclusion

          In a large contemporary French patient population, real world practice showed a recent shift towards a lower age-threshold for biological SAVR as compared to what would suggest contemporary guidelines.

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          Most cited references28

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          Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients.

          Martin Leon, Craig R Smith, Michael J Mack … (2016)
          Previous trials have shown that among high-risk patients with aortic stenosis, survival rates are similar with transcatheter aortic-valve replacement (TAVR) and surgical aortic-valve replacement. We evaluated the two procedures in a randomized trial involving intermediate-risk patients.
          Article 0 comments Cited 752 times – based on 0 reviews     Review now
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            2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.

            Catherine M Otto, Rick A. Nishimura, Robert Bonow … (2021)
            Article 0 comments Cited 213 times – based on 0 reviews     Review now
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              2021 ESC/EACTS Guidelines for the management of valvular heart disease

              Alec Vahanian, Friedhelm Beyersdorf, Fabien Praz … (2021)
              Article 0 comments Cited 194 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Cardiovasc Med
                Journal ID (iso-abbrev): Front Cardiovasc Med
                Journal ID (publisher-id): Front. Cardiovasc. Med.
                Title: Frontiers in Cardiovascular Medicine
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2297-055X
                Publication date (Electronic): 28 August 2023
                Publication date Collection: 2023
                Volume: 10
                Electronic Location Identifier: 1205770
                Affiliations
                [ 1 ]Department of Cardiac Surgery University Hospital Amiens-Picardie, Amiens, France
                [ 2 ]Laboratoire MP3CV-University Picarde Jules Vernes-UR7517, Amiens, France
                [ 3 ]Department of Cardiac Surgery University Paris Diderot, Paris, France
                [ 4 ]Department of Thoracic and Cardiovascular Surgery, Clinique du Millénaire , Montpellier, France
                [ 5 ]Department of Cardiovascular Surgery, University Hospital Pontchaillou , Rennes, France
                [ 6 ]Department of Cardiac Surgery, University Hospital of Angers , Angers, France
                Author notes

                Edited by: Stephanie Sellers, University of British Columbia, Canada

                Reviewed by: Takashi Kakuta, National Cerebral and Cardiovascular Center, Japan Michael Seidman, University Health Network (UHN), Canada

                [* ] Correspondence: Thierry Caus caus.thierry@ 123456chu-amiens.fr
                Article
                DOI: 10.3389/fcvm.2023.1205770
                PMC ID: 10493300
                PubMed ID: 37701140
                SO-VID: 4c7d81b4-2585-4a30-8a5a-9d57d4ef9e6a
                Copyright © © 2023 Caus, Chabry, Nader, Fusellier, De Brux and for the EpiCard investigators.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 14 April 2023
                Date accepted : 16 June 2023
                Page count
                Figures: 5, Tables: 4, Equations: 0, References: 28, Pages: 0, Words: 0
                Categories
                Subject: Cardiovascular Medicine
                Subject: Original Research
                Custom metadata
                section-at-acceptance Heart Valve Disease

                Keywords: aortic valve,surgical aortic replacement,mechanical and biological prosthetic valves,trend,database,france,bioprosthesis,mechanical prosthesis
                Data availability:
                Keywords: aortic valve, surgical aortic replacement, mechanical and biological prosthetic valves, trend, database, france, bioprosthesis, mechanical prosthesis

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