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Surgical Aortic Valve Replacement in Patients Aged 50 to 70 Years: Mechanical or Bioprosthetic Valve? A Systematic Review

Although transcatheter aortic valve implantation has emerged as a very attractive treatment option for severe aortic valve disease, surgical aortic valve replacement (SAVR) is still considered the standard-of-care, particularly in younger patients. However, selecting the appropriate type of valve pr...

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Autores principales: Sigala, Evangelia, Kelesi, Martha, Terentes-Printzios, Dimitrios, Vasilopoulos, Georgios, Kapadohos, Theodoros, Papageorgiou, Dimitrios, Tzatzou, Alexia, Vlachopoulos, Charalambos, Stavropoulou, Areti
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10298478/
https://www.ncbi.nlm.nih.gov/pubmed/37372888
http://dx.doi.org/10.3390/healthcare11121771
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author Sigala, Evangelia
Kelesi, Martha
Terentes-Printzios, Dimitrios
Vasilopoulos, Georgios
Kapadohos, Theodoros
Papageorgiou, Dimitrios
Tzatzou, Alexia
Vlachopoulos, Charalambos
Stavropoulou, Areti
author_facet Sigala, Evangelia
Kelesi, Martha
Terentes-Printzios, Dimitrios
Vasilopoulos, Georgios
Kapadohos, Theodoros
Papageorgiou, Dimitrios
Tzatzou, Alexia
Vlachopoulos, Charalambos
Stavropoulou, Areti
author_sort Sigala, Evangelia
collection PubMed
description Although transcatheter aortic valve implantation has emerged as a very attractive treatment option for severe aortic valve disease, surgical aortic valve replacement (SAVR) is still considered the standard-of-care, particularly in younger patients. However, selecting the appropriate type of valve prosthesis for this patient population can pose challenges. The aim of this systematic review was to investigate morbidity and mortality in patients aged 50–70 years who have undergone a first-time SAVR, and to define and compare the outcomes of mechanical valve (MV) and biological valve (BV) prosthesis. A systematic search was conducted to investigate the clinical outcomes of MVs and BVs in patients aged 50–70 years following the PRISMA guidelines. A total of 16,111 patients were included in the studies with an average follow-up of 10 years. A total of 16 studies were selected, 12 of which included propensity-score-matching (PMS) analysis and 4 of which obtained results via multivariate analysis. The vast majority (13 studies) showed no greater survival benefit in either MVs and BVs, while three studies showed an advantage of MVs over BVs. Regarding complications, bleeding was the most common adverse event in patients undergoing MV replacement, while for patients receiving BV prosthesis, it was structural valve deterioration and reoperation. Although the data suggest that the BV option could be a safe option in patients younger than 70 years, more studies with contemporary data are needed to draw firm conclusions on the risks and benefits of BV or MV in SAVR. Physicians should individualize the surgical plan based on patient characteristics.
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spelling pubmed-102984782023-06-28 Surgical Aortic Valve Replacement in Patients Aged 50 to 70 Years: Mechanical or Bioprosthetic Valve? A Systematic Review Sigala, Evangelia Kelesi, Martha Terentes-Printzios, Dimitrios Vasilopoulos, Georgios Kapadohos, Theodoros Papageorgiou, Dimitrios Tzatzou, Alexia Vlachopoulos, Charalambos Stavropoulou, Areti Healthcare (Basel) Systematic Review Although transcatheter aortic valve implantation has emerged as a very attractive treatment option for severe aortic valve disease, surgical aortic valve replacement (SAVR) is still considered the standard-of-care, particularly in younger patients. However, selecting the appropriate type of valve prosthesis for this patient population can pose challenges. The aim of this systematic review was to investigate morbidity and mortality in patients aged 50–70 years who have undergone a first-time SAVR, and to define and compare the outcomes of mechanical valve (MV) and biological valve (BV) prosthesis. A systematic search was conducted to investigate the clinical outcomes of MVs and BVs in patients aged 50–70 years following the PRISMA guidelines. A total of 16,111 patients were included in the studies with an average follow-up of 10 years. A total of 16 studies were selected, 12 of which included propensity-score-matching (PMS) analysis and 4 of which obtained results via multivariate analysis. The vast majority (13 studies) showed no greater survival benefit in either MVs and BVs, while three studies showed an advantage of MVs over BVs. Regarding complications, bleeding was the most common adverse event in patients undergoing MV replacement, while for patients receiving BV prosthesis, it was structural valve deterioration and reoperation. Although the data suggest that the BV option could be a safe option in patients younger than 70 years, more studies with contemporary data are needed to draw firm conclusions on the risks and benefits of BV or MV in SAVR. Physicians should individualize the surgical plan based on patient characteristics. MDPI 2023-06-15 /pmc/articles/PMC10298478/ /pubmed/37372888 http://dx.doi.org/10.3390/healthcare11121771 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Sigala, Evangelia
Kelesi, Martha
Terentes-Printzios, Dimitrios
Vasilopoulos, Georgios
Kapadohos, Theodoros
Papageorgiou, Dimitrios
Tzatzou, Alexia
Vlachopoulos, Charalambos
Stavropoulou, Areti
Surgical Aortic Valve Replacement in Patients Aged 50 to 70 Years: Mechanical or Bioprosthetic Valve? A Systematic Review
title Surgical Aortic Valve Replacement in Patients Aged 50 to 70 Years: Mechanical or Bioprosthetic Valve? A Systematic Review
title_full Surgical Aortic Valve Replacement in Patients Aged 50 to 70 Years: Mechanical or Bioprosthetic Valve? A Systematic Review
title_fullStr Surgical Aortic Valve Replacement in Patients Aged 50 to 70 Years: Mechanical or Bioprosthetic Valve? A Systematic Review
title_full_unstemmed Surgical Aortic Valve Replacement in Patients Aged 50 to 70 Years: Mechanical or Bioprosthetic Valve? A Systematic Review
title_short Surgical Aortic Valve Replacement in Patients Aged 50 to 70 Years: Mechanical or Bioprosthetic Valve? A Systematic Review
title_sort surgical aortic valve replacement in patients aged 50 to 70 years: mechanical or bioprosthetic valve? a systematic review
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10298478/
https://www.ncbi.nlm.nih.gov/pubmed/37372888
http://dx.doi.org/10.3390/healthcare11121771
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