Mechanical aortic valve replacement (AVR) provides significant long-term survival benefits for patients aged 60 and younger compared to bioprosthetic valves, research presented at the 2025 Society of Thoracic Surgeons (STS) annual meeting (25–27 January, Los Angeles, USA) suggests.
The study, leveraging data from the STS Adult Cardiac Surgery Database (ACSD) encompasses over 100,000 patients, addressing the question: how age and valve type influence outcomes for patients undergoing surgical AVR. It found that patients aged 60 and younger had lower all-cause mortality with mechanical valves.
Elsewhere the study points towards a decline in mechanical valve use, from 20% to 10% over the study’s 12-year period, even though mechanical valves were independently associated with a lower risk of all-cause mortality in patients 60 years or younger.
“The decision between a bioprosthetic and mechanical valve is one of the most consequential for patients requiring aortic valve replacement,” said Michael Bowdish, lead author of the study and a cardiothoracic surgeon at Cedars-Sinai Medical Center in Los Angeles. “Our research underscores that for patients with an age threshold of 60 years, mechanical valves confer a significant survival advantage. This data will help patients and providers make more informed choices about their care.”
The findings are particularly relevant considering the increasing adoption of bioprosthetic surgical valves in many patients and the recent trend of bioprosthetic transcatheter aortic valve implantation (TAVI) in younger populations without clear evidence, the researchers behind the study suggest. The current study challenges this practice trend given this important evidence favouring the durability and survival benefits of mechanical valves in patients aged 60 and younger, according to a press release from STS.
