Trends in isolated aortic valve replacement in middle‐aged patients over the last 10 years: epidemiology, risk factors, valve pathology, valve types, and outcomes

688 However, the real world studies have shown excel‐ lent outcomes of SAVR in low ‐risk, intermediate‐ ‐risk, and high ‐risk patients. To ensure excellent long ‐term results with improved long ‐term mor‐ tality and morbidity rates, appropriate selection of valve prosthesis in SAVR is essential. The valve prosthesis selection process is the most difficult in middle ‐aged (borderline) INTRODUCTION Aortic valve disease is a com‐ mon heart condition, which – if progressive – re‐ quires intervention. Over the last decade, the once predominant surgical aortic valve replacement (SAVR) has been replaced by the transcatheter aor‐ tic valve implantation (TAVI). Currently, TAVI may be performed in older patients considered inter‐ mediate‐ or high ‐risk for conventional surgery.1‐3 Correspondence to: Radosław Litwinowicz, MD, PhD, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland, phone: +48 12 614 32 03, email: radek.litwinowicz@gmail.com Received: April 17, 2019. Revision accepted: May 29, 2019. Published online: May 29, 2019. Kardiol Pol. 2019; 77 (7‐8): 688‐695 doi:10.33963/KP.14854 Copyright by the Author(s), 2019 * GF and RL contributed equally to this work. ABSTRACT BACKGROUND Valve prosthesis selection in aortic valve replacement (AVR) is particularly difficult in middle ‐aged patients (60–70 years old). AIMS We described changes in trends and outcomes of AVR in middle ‐aged patients over the last 10 years, based on the real ‐life single ‐center data from the Polish National Registry. METHODS A total of 4912 consecutive adult patients who underwent any type of isolated aortic valve surgery between 2006 to 2016 were included. The main outcome measures were changes in the number of procedures, characteristics, surgical details, and in ‐hospital mortality. RESULTS Out of all 4912 AVR procedures performed, 1531 patients (31.2%) were between 60 and 70 years of age. The share of aortic valve prosthesis in the overall number of replacements changed between 2006 and 2016 for mechanical valves (MV) from 98.3% to 15.2% and for biological valves (BV) from 0% to 81.8% (P <0.001 for both comparisons). In the BV group, stented valves were implanted in 92.6%. The most common MV was the St. Jude Medical Mechanical Heart Valve (St. Jude Medical, Saint Paul, Minnesota, United States) and most common BV was the Carpentier ‐Edwards Perimount Magna (Edwards Lifesciences, Irvine, California, United States). The most common prosthesis size was 23 mm. There were no significant differences in body mass index and comorbidities between the patients with MV and BV. The overall in ‐hospital mortality was 3.46% (3.33% in the MV group and 3.69% in the BV group; P = 0.85). CONCLUSIONS In the last 10 years, one ‐third of aortic valve replacements were performed in patients between 60 and 70 years of age. We observed rapidly changing trends in the type of implanted valve prostheses.