Mechanical aortic valve replacement demonstrated significant long-term survival benefits compared with bioprosthetic valves in patients aged 60 years and younger, according to a new study.

In the study, presented at the 2025 Society of Thoracic Surgeons (STS) Annual Meeting, investigators analyzed data from more than 100,000 patients in the STS Adult Cardiac Surgery Database. The study represented one of the most comprehensive analyses of prosthetic valve outcomes to date.

The investigation revealed that despite superior outcomes in younger populations, the utilization of mechanical valves decreased from 20% to 10% during the 12-year study period. The research methodology combined patient-level data from the Adult Cardiac Surgery Database (ACSD) with the National Death Index to ensure validated outcomes assessment.

"The decision between a bioprosthetic and mechanical valve is one of the most consequential for patients requiring aortic valve replacement," stressed lead study author Michael Bowdish, MD, a cardiothoracic surgeon at Cedars-Sinai Medical Center in Los Angeles. "Our research underscores that for patients with an age threshold of 60 years, mechanical valves confer a significant survival advantage," he added.

The findings challenged current practice trends, particularly regarding the increasing adoption of bioprosthetic surgical valves and the recent expansion of bioprosthetic transcatheter aortic valve replacement (TAVR) into younger populations without substantial supporting evidence.

Senior study author Vinay Badhwar, MD, of West Virginia University, noted that current practice patterns have evolved without robust clinical evidence. "With national clinical evidence from over 100,000 patients and over 10-year survival follow-up, the signal of the survival benefit of mechanical valves starts at age 65 but is most clear at age 60 or younger," Dr. Badhwar said. "This new important information may give surgeons and cardiologists some pause when suggesting biological solutions to younger patients," he continued.

The research leveraged data from the STS National Database, which encompasses nearly 10 million cardiothoracic procedures performed by more than 4,300 surgeons. The database captures over 95% of adult and congenital cardiac surgery procedures and most lung and esophageal cancer surgeries in the United States, providing comprehensive national benchmarks for cardiothoracic surgery outcomes.

"While care must always be individualized between the patient and provider, perhaps lifetime management in these particular patients may be better served with a mechanical prosthesis to mitigate the nontrivial mortality and morbidity risk of reoperation or reintervention and to optimize long-term survival," Dr. Badhwar concluded.

The study's methodology integrated the ACSD with the National Death Index, creating what Dr. Bowdish described as "a powerful tool to analyze long-term outcomes, paving the way for more personalized and effective care."