Mechanical surgical aortic valve replacement (AVR) is independently associated with significant survival benefits compared with bioprosthetic AVR in patients aged 60 years and younger, a real-world analysis shows. These data were reported by Michael E. Bowdish, MD, MS, of Cedars-Sinai Medical Center, Los Angeles, and colleagues, in a manuscript published online in the Journal of the American College of Cardiology. Provider recommendations and individual patient selection conflict when it comes to surgical AVR, particularly in younger patients. Joint decision-making should consider patient-specific valve durability with the potential risks of oral anticoagulation (OAC). The investigators of this study examined AVR outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Data base (STS-ACSD) in patients undergoing isolated bioprosthetic or mechanical AVR. This contemporary, real-world, longitudinal study excluded patients under 40 years or over 75 years of age who had endocarditis, emergency/salvage status, shock, ejection fraction ≤25% and any prior cardiac surgery. Longitudinal mortality was determined using the National Death Index. Pure aortic insufficiency, intermediate/high risk (STS>4%) and discontinued valve types were excluded in the sensitivity analyses. During the study period, 94,125 patients underwent bioprosthetic AVR and 15,717 patients underwent mechanical AVR. Freedom from all-cause mortality was associated more heavily with mechanical valves before age 60, after adjusting for risks. Mechanical valves were associated with lower all-cause mortality in all age groups that were ≤60 years old. All sensitivity analyses had the same conclusions. This study had a few limitations. First, the retrospective nature of the study may have limited causality, despite the STS-ACSD capturing 97% of AVR operations in the U.S. Additionally, the dataset does not provide analyses for transcatheter valve therapies post-AVR or long-term thromboembolic or bleeding rates. Overall, patients under 60 years of age who underwent mechanical AVR had lower rates of all-cause mortality than those who underwent bioprosthetic AVR. Source: Bowdish ME, Mehaffey JH, Chang SC, et al. Bioprosthetic vs Mechanical Aortic Valve Replacement in Patients 40-75 Years. J Am Coll Cardiol. 2025 Feb 1 (Article in Press). Image Credit: ungvar – stock.adobe.com