Valvular & structural heart disease
Comparative evaluation of biological and mechanical prostheses for aortic valve replacement in a middle-aged population: a population-based cohort study
Authors' conclusion
Among middle-aged Asian patients undergoing AVR, biological and mechanical prostheses yield similar long-term survival, yet biological prostheses carry a lower risk of major adverse events, especially in those aged 55-64. Opting for biological prostheses at a younger age, potentially starting at age 55, may offer advantages in improving long-term outcomes.
Study context
- Population
- Patients aged 45–64 years who underwent aortic valve replacement (AVR) between 2006 and 2021, Taiwan's national claims databasematched pairs of patients with biological or mechanical prostheses
- Participants
- 1,136 patients
- Exposure
- AVR with mechanical versus biological prostheses
- Outcome
- All-cause mortality
Methodological detailspopulation-based, propensity score matching, national claims database, 46 hospitals
- Population-based
- Propensity score matching
- National claims database
- 46 hospitals
Main finding
As reported in the abstract
- All-cause mortality did not significantly differ between prosthesis groups
- Overall cohort
Observational data: associations, not effects.
Further findings
| Outcome | RMST difference (years) (95% CI) | |
|---|---|---|
| Major adverse prosthesis-related events (major bleeding, ischaemic stroke, aortic valve reoperation, endocarditis and sudden cardiac death) · 10-yearBiological prosthesesvs mechanical prostheses | 0.68 (0.38–0.98) | |
| −0.500.51Difference, years (linear scale) |
| Outcome | sHR (95% CI) | |
|---|---|---|
| Major adverse prosthesis-related events (major bleeding, ischaemic stroke, aortic valve reoperation, endocarditis and sudden cardiac death) · 10-yearBiological prosthesesvs mechanical prostheses | 0.69 (0.59–0.81) | |
| 0.512Subdistribution hazard ratio (log scale) |
- Major adverse prosthesis-related events (major bleeding, ischaemic stroke, aortic valve reoperation, endocarditis and sudden cardiac death): fewer major adverse prosthesis-related events with biological prostheses
Age-stratified analyses (45-54 and 55-64 years)
- Outcomes were comparable between types in patients aged 45-54
- Biological prostheses were associated with similar survival but fewer adverse events in those aged 55-64
Follow-up
- Follow-up of up to 17 years
- 17 years
Original publication
Comparative evaluation of biological and mechanical prostheses for aortic valve replacement in a middle-aged population: a population-based cohort study. Heart. Published 16 July 2025. doi:10.
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