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March 16, 2022

When an Aortic Bioprosthesis Fails in a Low-risk Patient, Randomize

Author Affiliations
  • 1Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
  • 2Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
JAMA Cardiol. 2022;7(5):473-474. doi:10.1001/jamacardio.2022.0111

Aortic stenosis is the most commonly treated valvular heart disease. Surgical aortic valve replacement (SAVR) allows the implantation of either a mechanical or biological artificial heart valve prosthesis. Current guidelines recommend mechanical valves for SAVR in patients who are younger than 50 and 60 years in the United States and Europe, respectively.1,2 Nonetheless, the majority of aortic prostheses implanted during SAVR are bioprostheses. Moreover, between 1997 and 2002, this number doubled in the United States. Similarly, the fraction of SAVR bioprostheses in the United Kingdom increased from 65.4% to 77.8% between 2004 and 2009, while in Germany, the fraction of mechanical valves declined from 15.9% to 9.0% between 2010 and 2019. Although the trend toward more aortic bioprostheses can be observed throughout all age ranges, it is strongest in patients who are in their sixth decade of life.3 Because bioprostheses implanted in younger individuals frequently develop structural valve deterioration over time, the clinical challenge of aortic valve reintervention due to structural valve deterioration has become increasingly common.

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