Structural Heart

Why Mechanical AVR Valves Still Matter

A presentation at this year’s Society of Thoracic Surgeons (STS) conference suggests mechanical valves might lead to better survival compared to bioprosthetic valves in patients aged 60 or younger undergoing SAVR even though it seems like they’re going out of style.

  • Mechanical SAVR valves have been around in one form or another since the 1960s, but have fallen out of favor in recent years.
  • Previous analyses suggested mechanical valves have advantages over tissue valves in middle-aged patients, but lifelong anticoagulation requirements makes them a hard sell. 

Researchers examined STS registry data on ~109k patients ages 40 to 75 years who received isolated bioprosthetic (94k) or mechanical (15k) AVR over 11 years and found that mechanical valve use decreased by about half (from 20% in 2008 to below 10% in 2019).

Despite the declining use of mechanical AVR, its benefits were clear over the study’s median 5.4 year follow-up, with patients aged 40-59 seeing the most significant mortality benefits.

  • Patients aged 40-49 had a 31% lower all-cause mortality risk when receiving mechanical AVR compared to bioprosthetic.
  • For patients aged 50-59, the benefit was less dramatic, but still significant coming in at a 13% lower all-cause mortality risk.

While these mortality risks might seem convincing, there are several caveats to keep in mind, including the significant differences in patient characteristics between mechanical and bioprosthetic recipients.

  • Patients receiving bioprosthetic valves tended to be older (65.2 vs 55.7 years).
  • They also often had lower BMI (31.0 vs 32.2 kg/m2).
  • Bioprosthetic patients also had higher rates of hypertension (78.7% vs 71.8%) or prior PCI (6.7 vs 3.7%).
  • However, bioprosthetic recipients had severe aortic insufficiency less often (15.3% vs 23.6%).

The study’s design also wasn’t powered to make any certain conclusions due to its reliance on registry data, meaning a randomized head-to-head trial would be needed to confirm these outcomes.

The Takeaway

When it comes to AVR, it’s pretty clear that it’s not a “one-valve fits all” type of situation, especially in the case of mechanical valves. While the data is still less-than-certain, this presentation suggests that there could be benefits to keeping mechanical AVR on the table, at least for healthier patients under 60.

Get twice-weekly insights on the biggest stories shaping cardiology.

You might also like

Cardiac Imaging June 16, 2025

Beyond Hardware: Is AI the Answer to Making Cardiac Imaging more Accessible? June 16, 2025

Sponsored by Philips Healthcare Cardiac imaging has traditionally improved through hardware advances, enabling the speed needed for high-quality images. However, hardware is rapidly reaching its physical limitations in suppressing cardiac motion and represents a large financial investment. Today, software and AI are driving the next leap in cardiac image quality and motion control – offering […]

Cardiology Pharmaceuticals June 12, 2025

FDA Approves a New BP Triple Polypill June 12, 2025

Bringing a more effective BP therapy to the U.S. market, the FDA approved George Medicines’ triple therapy polypill called Widaplik for patients with hypertension, making it the first of its kind to go to market in the U.S. Widaplik’s approval stems from two studies, including one comparing the polypill against placebo as an initial treatment […]

Cardiology Pharmaceuticals June 12, 2025

Pharmacologic Preconditioning to Improve Outcomes in Patients Undergoing Cardiac Surgery  June 12, 2025

The majority of patients undergoing cardiac surgery, especially those on cardiopulmonary bypass (CPB), experience post-operative complications such as new-onset atrial fibrillation (POAF) and acute kidney injury (AKI), largely driven by oxidative stress and inflammation.   Several approaches have been explored to reduce complications following cardiac surgery, however, a clinically meaningful impact has yet to be realized.  […]

You might also like..

Select All

You're signed up!

It's great to have you as a reader. Check your inbox for a welcome email.

-- The Cardiac Wire Team

You're all set!