REAL-WORLD OUTCOMES OF MECHANICAL, PORCINE, AND DURABLE VALVES IN SEVERE AORTIC STENOSIS: SURVIVAL, REINTERVENTION, AND EARLY MORTALITY ANALYSIS
Author(s)
Ya-Ping Hung, Master1, Ting-Fang Chen, Master2, CHING-HU CHUNG3.
1Edwards Lifesciences, Taipei, Taiwan, 2Edwards Lifesciences, TAIPEI, Taiwan, 3School of Medicine, College of Medicine, MacKay Medical University, New Taipei City, Taiwan.
1Edwards Lifesciences, Taipei, Taiwan, 2Edwards Lifesciences, TAIPEI, Taiwan, 3School of Medicine, College of Medicine, MacKay Medical University, New Taipei City, Taiwan.
OBJECTIVES: To compare long-term survival, healthcare costs, and reintervention rates among patients with severe aortic stenosis (AS) undergoing aortic valve replacement (AVR) using mechanical valves (MV), porcine valves (PV), or durable valves (DV), and to elucidate mechanisms underlying early (≤30-day) postoperative mortality across valve types.
METHODS: This retrospective cohort study analyzed patients with severe AS who underwent AVR between 2014 and 2023 using Taiwan’s National Health Insurance Research Database. Patients were categorized into MV (n=3,213), PV (n=3,227), and DV (n=4,713) groups. Primary outcomes included all-cause mortality, cumulative medical costs, and valve reoperation. Early postoperative mortality (≤30 days) was assessed separately. Baseline characteristics and cause-of-death records were examined to explore mechanisms of early mortality. Multivariable regression and survival analyses were performed.
RESULTS: Overall survival differed significantly by valve type. DV recipients demonstrated superior long-term survival compared with MV and PV recipients. Early mortality was significantly higher in the MV and PV groups than in the DV group (9.27% vs. 12.02% vs. 4.12%). Among early deaths, MV recipients had a markedly higher proportion of deaths due to aortic aneurysm or dissection compared with DV recipients (49.66% vs. 17.53%). PV recipients who experienced early mortality were older and had higher comorbidity burdens, with increased prevalence of infective endocarditis and coronary atherosclerotic disease compared with DV recipients. Cumulative healthcare costs were higher in valve groups associated with greater postoperative complications or reintervention.
CONCLUSIONS: n patients with severe AS undergoing AVR, DV implantation was associated with improved long-term survival and lower early postoperative mortality. Excess early mortality in MV and PV recipients appears to arise from distinct mechanisms related to aortic pathology and patient comorbidity profiles, highlighting the importance of individualized valve selection.
METHODS: This retrospective cohort study analyzed patients with severe AS who underwent AVR between 2014 and 2023 using Taiwan’s National Health Insurance Research Database. Patients were categorized into MV (n=3,213), PV (n=3,227), and DV (n=4,713) groups. Primary outcomes included all-cause mortality, cumulative medical costs, and valve reoperation. Early postoperative mortality (≤30 days) was assessed separately. Baseline characteristics and cause-of-death records were examined to explore mechanisms of early mortality. Multivariable regression and survival analyses were performed.
RESULTS: Overall survival differed significantly by valve type. DV recipients demonstrated superior long-term survival compared with MV and PV recipients. Early mortality was significantly higher in the MV and PV groups than in the DV group (9.27% vs. 12.02% vs. 4.12%). Among early deaths, MV recipients had a markedly higher proportion of deaths due to aortic aneurysm or dissection compared with DV recipients (49.66% vs. 17.53%). PV recipients who experienced early mortality were older and had higher comorbidity burdens, with increased prevalence of infective endocarditis and coronary atherosclerotic disease compared with DV recipients. Cumulative healthcare costs were higher in valve groups associated with greater postoperative complications or reintervention.
CONCLUSIONS: n patients with severe AS undergoing AVR, DV implantation was associated with improved long-term survival and lower early postoperative mortality. Excess early mortality in MV and PV recipients appears to arise from distinct mechanisms related to aortic pathology and patient comorbidity profiles, highlighting the importance of individualized valve selection.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO128
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment, Comparative Effectiveness or Efficacy
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), STA: Surgery