Valvular & structural heart diseaseMeta-analysis
Mechanical versus biological aortic valve replacement in patients aged 50–70 years: a systematic review and meta-analysis
- systematic review and meta-analysis of randomised and observational studies
- inverse variance random-effects meta-analysis
Authors' conclusion
Drawing largely from observational data, mechanical valves were associated with superior overall survival but increased bleeding due to lifelong anticoagulation. Bioprosthetic valves offer lower bleeding risk but higher reoperation rates from structural degeneration. The growing use of bioprosthetic valves in this age group may lead to more reinterventions in older, more comorbid patients. Contemporary randomised trials are needed to evaluate outcomes with modern valve designs.
Study context
- Population
- Patients aged 50–70 years undergoing mechanical or bioprosthetic aortic valve replacement (AVR)30 studies, 29 of which were observational
- Participants
- 120,844 patients
- Comparison
- mechanical and bioprosthetic AVR
- Outcome
- Overall survival
Pooled result
As reported in the abstract
Hazard ratio
0.88
95% CI 0.81–0.94
P = 0.001
Mechanical valves vs Bioprosthetic valves
HR 0.88 (95% CI 0.81–0.94); P = 0.001
Further pooled results
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Stroke · did not differ significantly · secondary outcome | 1.07 (0.91–1.27) | P = 0.37 | |
| Reoperation · bioprosthetic valves had higher reoperation rates · secondary outcome | 0.44 (0.33–0.57) | P < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
Safety
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Major bleeding · higher risk with mechanical valves · secondary outcome | 1.60 (1.43–1.78) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
Original publication
Mechanical versus biological aortic valve replacement in patients aged 50–70 years: a systematic review and meta-analysis. Heart. Published 18 March 2026. doi:10.1136/heartjnl-2025-327763
Summarised from the published abstract; every number is checked against it