TY - JOUR
T1 - Predictors of use and outcomes of mechanical valve replacement in the United States (2008–2017)
AU - Alkhouli, Mohamad
AU - Nishimura, Rich A.
AU - Alqahtani, Fahad
AU - Simard, Trevor
AU - Pislaru, Sorin
AU - Schaff, Hartzell V.
N1 - Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2021/5/4
Y1 - 2021/5/4
N2 - BACKGROUND: Contemporary nationwide data on the use, predictors, and outcomes of mechanical valve replacement in patients less than 70 years of age are limited. METHODS AND RESULTS: We identified hospitalizations for aortic valve replacement (AVR) or mitral valve replacement (MVR) in the Nationwide Inpatient Sample between January 1, 2008, and December 31, 2017. The study’s end points included predic-tors of mechanical valve replacement and risk-adjusted in-hospital mortality. Among 253 100 hospitalizations for AVR, the use rate of mechanical prosthesis decreased from 45.3% in 2008 to 17.0% in 2017. Among 284 962 hospitalizations for MVR, mechanical prosthesis use decreased from 59.5% in 2008 to 29.2% in 2017 (P for trend<0.001). In multilogistic regression analyses, female sex, prior sternotomy, prior defibrillator, and South/West geographic location were predictive of mechanical valve use. The presence of bicuspid valve was a negative predictor of mechanical AVR (odds ratio [OR], 0.68; 95% CI, 0.66– 0.69; P<0.001), whereas mitral stenosis was associated with higher mechanical MVR (OR, 1.28; 95% CI, 1.22–1.33; P<0.001). Unadjusted in-hospital mortality decreased over time with AVR but not with MVR, regardless of prosthesis choice. Using years 2008 and 2009 as a reference, risk-adjusted mortality also decreased over time with AVR but did not decrease after MVR. CONCLUSIONS: There is a substantial decline in the use of mechanical valve replacement among patients aged ≤70 years in the United States. Long-term durability data on bioprosthetic valve replacement are needed to better define the future role of mechanical valves in this age group.
AB - BACKGROUND: Contemporary nationwide data on the use, predictors, and outcomes of mechanical valve replacement in patients less than 70 years of age are limited. METHODS AND RESULTS: We identified hospitalizations for aortic valve replacement (AVR) or mitral valve replacement (MVR) in the Nationwide Inpatient Sample between January 1, 2008, and December 31, 2017. The study’s end points included predic-tors of mechanical valve replacement and risk-adjusted in-hospital mortality. Among 253 100 hospitalizations for AVR, the use rate of mechanical prosthesis decreased from 45.3% in 2008 to 17.0% in 2017. Among 284 962 hospitalizations for MVR, mechanical prosthesis use decreased from 59.5% in 2008 to 29.2% in 2017 (P for trend<0.001). In multilogistic regression analyses, female sex, prior sternotomy, prior defibrillator, and South/West geographic location were predictive of mechanical valve use. The presence of bicuspid valve was a negative predictor of mechanical AVR (odds ratio [OR], 0.68; 95% CI, 0.66– 0.69; P<0.001), whereas mitral stenosis was associated with higher mechanical MVR (OR, 1.28; 95% CI, 1.22–1.33; P<0.001). Unadjusted in-hospital mortality decreased over time with AVR but not with MVR, regardless of prosthesis choice. Using years 2008 and 2009 as a reference, risk-adjusted mortality also decreased over time with AVR but did not decrease after MVR. CONCLUSIONS: There is a substantial decline in the use of mechanical valve replacement among patients aged ≤70 years in the United States. Long-term durability data on bioprosthetic valve replacement are needed to better define the future role of mechanical valves in this age group.
KW - Aortic valve replacement
KW - Bioprosthetic valve
KW - Mechanical valve
KW - Mitral valve replacement
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U2 - 10.1161/JAHA.120.019929
DO - 10.1161/JAHA.120.019929
M3 - Article
C2 - 33870704
AN - SCOPUS:85105769087
SN - 2047-9980
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 9
M1 - e019929
ER -