National Readmission Rates Post Surgical Heart Valve Replacement: A Comparative Analysis of Tissue and Mechanical Valves

OBJECTIVES: The AHA/ACC guidelines recommend shared decision making between surgeons and patients regarding the choice between tissue and mechanical valves for surgical heart valve replacement. Mechanical valves necessitate lifelong anticoagulation which can increase the risk of bleeding and impose a significant burden on patients and the healthcare system. This study aims to understand the impact of valve choice on the rate of bleeding-related readmissions post-surgical aortic and mitral valve procedures.

METHODS: Patients who received surgical aortic valve or mitral valve replacement procedures in 2018-2020 were identified in the Nationwide Readmissions Database (NRD) using standard ICD-10 procedure codes. In separate analyses for aortic and mitral patients, mechanical valve recipients were propensity-matched to zooplastic tissue valve recipients using survey-adjusted logistic regression to account for baseline differences in patient and procedure characteristics, including concomitant procedures. Survey-adjusted Kaplan-Meier plots comparing time to first bleeding-related readmission through one year in tissue vs mechanical valve recipients were created and differences were evaluated using the log-rank test.

RESULTS: Tissue valve recipients had lower bleeding-related readmission risk than mechanical valve recipients for both aortic and mitral valve groups (p<0.01). After 1 year of follow-up, tissue vs mechanical readmission rates were 5.2% vs 7.3% for aortic valve replacements and 8.6% vs 11.6% for mitral valve replacements, respectively.

CONCLUSIONS: US nationwide bleeding-related readmission rates were higher with mechanical valves compared to tissue valves for both surgical aortic and mitral valve replacements. This study adds to the existing body of literature around the burden of anticoagulation associated with mechanical valve usage. Patients and providers should consider these results during the shared decision-making process while selecting between tissue and mechanical valves.