Jeremy Chan, Maria Comanici, Pradeep Narayan, Tim Dong, Gianni D Angelini, CVD-COVID-UK/COVID-IMPACT Consortium
The use of biological prosthesis has increased incrementally since 2013 and persisted post-COVID-19 pandemic. Mechanical valves had a lower all-cause mortality, cumulative incidence of infective endocarditis, and need for repeat intervention. However, they were associated with a greater incidence of stroke and bleeding. The lifetime management of this group of patients remains complex, and long-term high-quality randomised controlled trials are required.
OBJECTIVE: In the last decade, there has been an increased use of biological prosthesis in patients aged 50 to 70 years old undergoing surgical aortic valve replacement (SAVR). The COVID-19 pandemic disrupted health care services, which may have affected this trend. This study aims to evaluate the trends in prosthesis use and long-term clinical outcomes in patients aged 50 to 70 years old who underwent SAVR before, during, and after the COVID-19 pandemic in the United Kingdom.
METHODS: This was a retrospective analysis of prospectively collected data in all patients aged 50 to 70 years who underwent first-time, elective/urgent isolated SAVR from January 2013 to April 2025.
RESULTS: A total of 11,010 patients underwent SAVR during the study period, with a median age of 63.4 years (first and third quartile: 58.6, 67.0 years), of whom 67% (n = 7359) were male. The use of biological prosthesis increased from 57.5% in 2013 to 71.3% in 2024. Patients who received a mechanical prosthesis when compared with a biological prosthesis had a lower all-cause mortality (hazard ratio, 1.22; 95% CI, 1.03-1.43; P = .021). The 1-, 5-, and 10-year survival rates were 98.02% versus 97.60%, 91.69% versus 91.66% and 81.08% versus 76.41%, respectively. Patients with a mechanical prosthesis had a greater cumulative incidence of cerebrovascular accident (adjusted subdistribution hazard ratio [sHR], 1.58; 95% CI, 1.13-2.22; P = .008) and major bleeding (sHR, 1.57; 95% CI, 1.15-2.14; P = .005) but a lower incidence of infective endocarditis (sHR, 0.43; 95% CI, 0.30-61; P < .001) and of repeat valvular intervention (sHR, 0.23; 95% CI, 0.09-0.55; P < .001).
CONCLUSIONS: The use of biological prosthesis has increased incrementally since 2013 and persisted post-COVID-19 pandemic. Mechanical valves had a lower all-cause mortality, cumulative incidence of infective endocarditis, and need for repeat intervention. However, they were associated with a greater incidence of stroke and bleeding. The lifetime management of this group of patients remains complex, and long-term high-quality randomised controlled trials are required.