Mechanical aortic valve prostheses offer a survival benefit in 50-65 year olds: AUTHEARTVISIT study

Denise Traxler, Pavla Krotka, Maria Laggner, Michael Mildner, Alexandra Graf, Berthold Reichardt, Ralph Wendt, Johann Auer, Bernhard Moser, Julia Mascherbauer, Hendrik Jan Ankersmit

Research output: Journal article (peer-reviewed)Journal article

9 Citations (Scopus)


BACKGROUND: The present population-based cohort study investigated long-term mortality after surgical aortic valve replacement (AVR) with bioprosthetic (B) or mechanical aortic valve prostheses (M) in a European social welfare state.

METHODS: We analysed patient data from health insurance records covering 98% of the Austrian population between 2010 and 2018. Subsequent patient-level record linkage with national health data provided patient characteristics and clinical outcomes. Further reoperation, myocardial infarction, heart failure and stroke were evaluated as secondary outcomes.

RESULTS: A total of 13,993 patients were analysed and the following age groups were examined separately: <50 years (727 patients: 57.77% M, 42.23% B), 50-65 years (2612 patients: 26.88% M, 73.12% B) and >65 years (10,654 patients: 1.26% M, 98.74% B). Multivariable Cox regression revealed that the use of B-AVR was significantly associated with higher mortality in patients aged 50-65 years compared to M-AVR (HR = 1.676 [1.289-2.181], p < 0.001). B-AVR also performed worse in a competing risk analysis regarding reoperation (HR = 3.483 [1.445-8.396], p = 0.005) and myocardial infarction (HR = 2.868 [1.255-6.555], p = 0.012). However, the risk of developing heart failure and stroke did not differ significantly after AVR in any age group.

CONCLUSIONS: Patients aged 50-65 years who underwent M-AVR had better long-term survival, and a lower risk of reoperation and myocardial infarction. Even though anticoagulation is crucial in patients with M-AVR, we did not observe significantly increased stroke rates in patients with M-AVR. This evident survival benefit in recipients of mechanical aortic valve prostheses aged <65 years critically questions current guideline recommendations.

Original languageEnglish
Article numbere13736
Pages (from-to)e13736
JournalEuropean Journal of Clinical Investigation
Issue number5
Publication statusPublished - May 2022


  • Aortic Valve/surgery
  • Bioprosthesis
  • Cohort Studies
  • Heart Failure/etiology
  • Heart Valve Prosthesis
  • Heart Valve Prosthesis Implantation/adverse effects
  • Humans
  • Myocardial Infarction/etiology
  • Retrospective Studies
  • Stroke/epidemiology
  • Treatment Outcome
  • mechanical valve replacement
  • aortic valve replacement
  • biological valve replacement
  • survival

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry


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