Tissue vs. Mechanical
Patient age is a key factor to consider when choosing an option for aortic valve replacement (AVR). Importantly, long-term survival (i.e., life expectancy) is directly affected by the type of valve and procedure you will choose to have. Below are several facts regarding aortic valve replacement with mechanical or tissue (bioprosthetic) valves in non-elderly patients (<60 years of age):
Although aortic valve replacement is a common operation, younger patients have a higher than expected risk of mortality (death) 10 years after a mechanical or a tissue (bioprosthetic) valve replacement compared to what would be expected in the general population.1 Data suggests that at 10 years after surgery, 1 in 5 patients who undergoes a mechanical aortic valve replacement at 50 years of age has died or required a reoperation.2
Similarly, very long-term outcomes in a study of over 2,500 patients with tissue valves in the aortic position further emphasize the impact on life expectancy for young patients. For patients approximately 40 years old at the time of surgery, the life expectancy was reduced by 20 years compared to that of general population.3
- This data suggests that a 42-year-old patient undergoing aortic valve replacement (AVR) with a tissue valve is expected to live to 58 years of age. In contrast, a 42-year-old in the general population is expected to live to 78 years of age. Similarly, patients undergoing AVR at the age of 60 years old have their life expectancy reduced by 8 years when compared to the general population.3
- See Figure A below for a comparison on life expectancy for patients undergoing aortic valve replacement and the general population not undergoing valve surgery.3
Valve Failure/Structural Valve Deterioration (SVD)
Additionally, valve failure (wear and tear over time), referred to as structural valve deterioration (SVD), remains a concern for patients of all ages who receive tissue valves. Importantly, the younger the patient is, the faster a tissue valve wears out.4
Figure A: Comparison of Life Expectancy after Aortic Valve Replacement (AVR) with Tissue (Bioprosthetic) Valves
and Relative Life Expectancy of the General Population in France.3
- Kvidal P et al., JACC 2000;35(3):747-56.
- Bouhout I et al., JTCVS 2014;148(4):1341-46.e1.
- Bourguignon T et al., Ann Thorac Surg 2015;99(3):831-37.
- Head S et al., Euro Heart J 2016;37:2668-70.