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Lookup NU author(s): Rebecca Maier, Dr David AustinORCiD, Professor Enoch AkowuahORCiD
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© Author(s) (or their employer(s)) 2026. No commercial re-use. See rights and permissions. Published by BMJ Group.Objectives: The optimal prosthetic aortic valve replacement (AVR) for long-term outcomes in patients aged 50–70 years remains uncertain. International guidelines differ; contemporary randomised trials are lacking, and use of bioprosthetic valves has increased. This review synthesised evidence comparing efficacy and safety outcomes between valve types in this age group. Methods: A systematic review and meta-analysis of randomised and observational studies comparing mechanical and bioprosthetic AVR in patients aged 50–70 years was conducted. Medline, Embase and the Cochrane Library were searched. The primary outcome was overall survival; secondary outcomes were major bleeding, reoperation and stroke. Data were pooled using inverse variance random-effects meta-analysis and presented as HRs with 95% CIs. Results: 30 studies involving 120 844 patients were included, 29 of which were observational. Mechanical valves were associated with better overall survival (HR 0.88; 95% CI 0.81 to 0.94; p=0.001). Stroke rates did not differ significantly (HR 1.07; 95% CI 0.91 to 1.27; p=0.37). Mechanical valves carried a higher risk of major bleeding (HR 1.60; 95% CI 1.43 to 1.78; p<0.001), while bioprosthetic valves had higher reoperation rates (HR 0.44; 95% CI 0.33 to 0.57; p<0.001). Conclusions: Drawing largely from observational data, mechanical valves were associated with superior overall survival but increased bleeding due to lifelong anticoagulation. Bioprosthetic valves offer lower bleeding risk but higher reoperation rates from structural degeneration. The growing use of bioprosthetic valves in this age group may lead to more reinterventions in older, more comorbid patients. Contemporary randomised trials are needed to evaluate outcomes with modern valve designs. PROSPERO registration number: CRD42024540272.
Author(s): Trevis J, Cheong J, Wilkinson C, Ogundimu E, Maier R, Austin D, Akowuah E
Publication type: Article
Publication status: Published
Journal: Heart
Year: 2026
Pages: epub ahead of print
Online publication date: 18/03/2026
Acceptance date: 02/03/2026
ISSN (print): 1355-6037
ISSN (electronic): 1468-201X
Publisher: BMJ Publishing Group
URL: https://doi.org/10.1136/heartjnl-2025-327763
DOI: 10.1136/heartjnl-2025-327763
PubMed id: 41850787
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