Controversy pro: Mechanical AVR for better long-term survival of 50-70 years old

Selection of the most appropriate type of aortic valve prosthesis (mechanical or biologic) for patients 50-70 years of age is a matter of frequent debate. The purpose of this article is to review overlooked concepts and misconceptions in valve-related complications, prosthesis durability, and late survival to aid decision making in contemporary practice. A trend favoring improved long-term survival was found among patients who receive a mechanical prosthesis compared to a biologic substitute. Additionally, an acceptably low rate of long-term valve-related thromboembolism and hemorrhage was found among those with mechanical prostheses. Implantation of a biologic valve substitute did not appear to reduce the risk of thromboembolism, may not eliminate the need for long-term anticoagulation and may be associated with an increased risk of late mortality. These findings may aid providers (and patients) in the preoperative consultation and seem to support consideration of a mechanical heart valve substitute over a biologic valve for patients 50-70 years age. (C) 2022 Elsevier Inc. All rights reserved.

Automated summary

The selection of the most appropriate type of aortic valve prosthesis (mechanical or biologic) for patients aged 50-70 is a contentious issue. This study found that patients who received a mechanical prosthesis had better long-term survival rates compared to those who received a biologic substitute. Additionally, the rate of valve-related thromboembolism and hemorrhage was acceptably low among patients with mechanical prostheses. These findings suggest that considering a mechanical heart valve substitute over a biologic valve may be beneficial for patients aged 50-70.