Biologische versus mechanische prothesen bij aortaklepvervanging op middelbare leeftijd

<sec><st>Background</st> <p>Current guidelines for aortic valve replacement (AVR) lack consensus on prosthesis selection in middle-aged patients. This study aimed to provide a comprehensive comparison of long-term outcomes following AVR with mechanical versus biological prostheses among middle-aged patients in an Asian population.</p> </sec> <sec><st>Methods</st> <p>This retrospective cohort study used Taiwan&rsquo;s national claims database, including patients aged 45&ndash;64 years who underwent AVR between 2006 and 2021 across 46 hospitals. Propensity score matching was applied to achieve covariate balance. Risks of all-cause mortality and major adverse prosthesis-related events (major bleeding, ischaemic stroke, aortic valve reoperation, endocarditis and sudden cardiac death) were compared using restricted mean survival time (RMST) and subdistribution HRs (sHRs) to account for competing risks. Subgroup analyses were performed for patients aged 45&ndash;54 and 55&ndash;64 years.</p>