Twenty-year experience following aortic valve replacement in patients younger than 60 years of age

Abstract

Abstract Objective: Reports on long-term outcomes of surgical aortic valve replacement (AVR) for patients aged <60 years are scarce in Japan. Hence, we aimed to evaluate these outcomes in patients aged <60 years. Methods: Between March 2000 and December 2020, 1477 patients underwent aortic valve replacement. In total, 170 patients aged <60 years who underwent aortic valve replacement were recruited. Patients aged <18 years were excluded. Patient data collected from the operative records and follow-up assessments were reviewed. Results: The mean age was 49±9 years, and 64.1% of patients were male. One-hundred-and-fifty-two patients (89.4%) underwent aortic valve replacement with a mechanical valve and 18 (10.6%) with a bioprosthetic valve. The mean follow-up period was 8.1±5.5 years. No operative mortality occurred, and in-hospital mortality occurred in one patient (0.6%). Ten late deaths occurred, with seven cardiac-related deaths. The overall survival rate was 95.4±1.7%, 93.9±2.3%, 90.6±3.9%, and 73.2±11.8% at 5, 10, 15, and 20 years, respectively. Freedom from major bleeding was 96.4±1.6% at 5, 10, and 15 years, and 89.0±7.3% at 20 years. Freedom from thromboembolic events was 98.7±1.3%, 97.3±1.9%, 90.5±4.5%, and 79.0±11.3% at 5, 10, 15, and 20 years, respectively. Freedom from valve-related reoperation was 99.4±0.6% at 5 years, 97.8±1.7% at 10 and 15 years, and 63.9±14.5% at 20 years. Conclusions: Patients aged <60 years undergoing aortic valve replacement with a high mechanical valve implantation rate had favorable long-term outcomes.