Ten-year reintervention-free survival after surgical aortic valve replacement for different prosthetic aortic valve models: comparison using real-world data from the Netherlands Heart Registration.
Abstract
Objectives
To compare long-term outcomes across different models of mechanical and biological aortic valve prostheses after surgical aortic valve replacement (SAVR) in the Netherlands.
Methods
Data from the Netherlands Heart Registration on isolated, primary SAVR procedures performed from 2007 to 2018 in adult patients were used, excluding active endocarditis. Ten-year survival and freedom from valve-related reintervention were estimated for models that were implanted >200 times, using Cox proportional hazards models for survival and Fine and Gray's models with death as the competing-event for freedom of reintervention.
Results
For 11,139 patients treated with a biological prosthetic aortic valve, ten-year survival was highest for the Perimount Magna Ease (72.6%) and Epic (70.0%), and significantly lower for the Perimount Magna (65.1%), Trifecta (63.1%), Perimount (61.4%), Freedom Solo (51.5%), and Mitroflow (50.7%). Ten-year freedom from reintervention was highest for the Perimount Magna (99.3%), and significantly lower for the Perimount Magna Ease (98.2%), Perimount (98.2%), Epic (97.3%), Trifecta (96.8%), Freedom Solo (93.2%) and Mitroflow (90.5%). For 2,123 patients treated with a mechanical prosthetic aortic valve, ten-year survival was highest for the Regent (91.2%) and not significantly different for the Open Pivot (89.2%), Slimline (87.5%), HP (87.3%) and significantly lower for the Carbomedics Reduced (87.0%). Ten-year freedom from reintervention was highest for the Carbomedics Reduced (97.1%), not significantly different for the Open Pivot (96.1%), Slimline (96.5%), Regent (95.9%), and significantly lower for the HP (94.9%).
Conclusions
Differences in ten-year outcomes after SAVR were observed for the different prosthetic aortic valve models that were used in the Netherlands Heart Registration, especially for biological prosthetic aortic valve models, with survival varying from 50.7% to 72.6% and freedom from reintervention from 90.5% to 99.3%.