Young SAVR patients live longer with mechanical valves—should surgeons, cardiologists rethink current practice?
Mechanical heart valves are associated with much better long-term outcomes than bioprosthetic heart valves when performing surgical aortic valve replacement (SAVR) on a patient 60 years old or younger, according to new research presented at STS 2025, the annual meeting of The Society of Thoracic Surgeons.
The analysis, based on data from nearly 110,000 SAVR patients, was simultaneously published in the Journal of the American College of Cardiology.[1]
“The decision between a bioprosthetic and mechanical valve is one of the most consequential for patients requiring aortic valve replacement,” lead author Michael Bowdish, MD, a cardiothoracic surgeon at Cedars-Sinai Medical Center in Los Angeles, said in a statement. “Our research underscores that for patients with an age threshold of 60 years, mechanical valves confer a significant survival advantage. This data will help patients and providers make more informed choices about their care.”
Bowdish et al. explored data from 109,842 patients between the ages of 40 and 75 who underwent SAVR from 2008 to 2019. Patients with pure aortic insufficiency were excluded to ensure all study participants could be seen as candidates for SAVR or transcatheter aortic valve replacement (TAVR). Data came from The Society of Thoracic Surgeons Adult Cardiac Surgery Database, and researchers used the National Death Index to confirm their findings were accurate.
While 86% of patients received a bioprosthetic valve, the other 14% received a mechanical valve. Patients receiving the two valve types had similar baseline characteristics, but those who received a mechanical valve tended to be much younger with a larger body mass index. In addition, patients receiving mechanical valves were more likely to present with severe aortic insufficiency, but less likely to present with hypertension or prior percutaneous coronary intervention.
Overall, mechanical SAVR was associated with a lower all-cause mortality rate than bioprosthetic SAVR. Age-specific Kaplan-Meier curves emphasized that the most significant difference in all-cause mortality was seen in patients 60 years old or younger.
Researchers also noted that care teams appear to be turning to mechanical valves less as time goes on. In fact, the percentage of mechanical valves being selected for SAVR decreased over the course of the study, dropping from approximately 20% to approximately 10% in a 12-year period.
This all comes at a time when more and more young patients with severe aortic stenosis (AS) are being treated with TAVR, which involves the implantation of bioprosthetic heart valves.
“Current practice has gradually evolved to implanting bioprostheses in patients of younger and younger age,” senior author Vinay Badhwar, MD, executive chair of the WVU Heart and Vascular Institute, said in the same statement. “This activity has not been informed by randomized trials or national clinical data, but by experiential practice or by state or administrative claims data. With national clinical evidence from over 100,000 patients and over 10-year survival follow-up, the signal of the survival benefit of mechanical valves starts at age 65, but is most clear at age 60 or younger. This new important information may give surgeons and cardiologists some pause when suggesting biological solutions to younger patients. While care must always be individualized between the patient and provider, perhaps lifetime management in these particular patients may be better served with a mechanical prosthesis to mitigate the non-trivial mortality and morbidity risk of reoperation or reintervention and to optimize long-term survival.”
Click here to read the full study in the Journal of the American College of Cardiology.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.