A Comparison of Long-Term Patient Outcomes after Heart Valve Replacement with Biological or Mechanical Valves in Medicare Beneficiaries

To compare mid- to long-term patient outcomes after heart valve replacement with mechanical to biological heart valves among elderly Medicare patients. This is a retrospective analysis of patients 65 years or older who underwent aortic valve replacement (AVR) in the 2006-2015 Medicare databases. Propensity analyses were used to control for bias in the treatment assignment and prognostic imbalance. Cox regression models were used to compare the long-term outcomes between mechanical and biological valves. Of the 125,507 Medicare beneficiaries who met inclusion criteria, 34,619 (27.6%) received a mechanical valve and 90,888 (72.4%) received a biological valve. Mechanic valve recipients had a slightly higher adjusted hazard ratio (HR) of death than recipients of biological valves (HR: 1.07; 95% CI 1.04, 1.09). Subgroup analyses showed the mortality was 16% higher for recipients of mechanical compared with biological valves within 30 days after the surgery (HR: 1.16; 95% CI 1.10, 1.22); and the mortality was 5% higher after 30 days (HR: 1.05; 95% CI 1.02, 1.07). The risk for reoperation was 43% higher for recipients of mechanical compared with biological valves (HR: 1.43; 95% CI 1.14, 1.80). Consistent findings were observed in the subgroup analyses by gender and age groups. In this cohort analyses of Medicare beneficiaries, mechanical valve recipients had higher risks of both death and reoperation. These data suggest that biological valves may be preferred in older patients.