Bioprosthetic versus mechanical tricuspid valve replacement: Biological age is not the same as chronological age

The authors reported no conflicts of interest.The Journal policy requires editors and reviewers to disclose interest decline handling or reviewing manuscripts for which they may have a conflict interest. this article We read with the population-based observational study by Sohn colleagues1Sohn S.H. Kang Y. Kim J.S. Hwang H.Y. K.H. Choi J.W. Early long-term outcomes bioprosthetic versus mechanical tricuspid valve replacement: nationwide study.J Thorac Cardiovasc Surg. February 4, 2023; ([Epub ahead print]. https://doi.org/10.1016/j.jtcvs.2023.01.025)Abstract Full Text PDF Scopus (1) Google Scholar comparing replacement (TVR), found that latter was associated higher mortality rates. These findings seem contradict large number previous studies describing difference between types,2Kaplan M. Kut M.S. Demirtas M.M. Cimen S. Ozler A. Prosthetic valve: mechanical.Ann 2002; 73: 467-473https://doi.org/10.1016/s0003-4975(01)03128-9Abstract PubMed (0) Scholar, 3Cho W.C. Park C.B. J.B. Jung Chung C.H. Choo S.J. et al.Mechanical in position.J Card 2013; 28: 212-217https://doi.org/10.1111/jocs.12093Crossref (21) 4Patlolla Saran N. Schaff H.V. Crestanello J. Pochettino Stulak J.M. al.Prosthesis choice comparison clinical echocardiographic outcomes.J July 8, 2022; https://doi.org/10.1016/j.jtcvs.2022.07.003)Abstract (3) including recent meta-analysis Negm colleagues.5Negm Arafat A.A. Elatafy E.E. Fawzy H.F. Mechanical position: systematic review meta-analysis.Heart Lung Circ. 2021; 30: 362-371https://doi.org/10.1016/j.hlc.2020.03.011Abstract (12) Proper interpretation therefore scrutiny confounders influenced observed outcomes, as well whether not these been adequately accounted for. It is known valves are preferentially used older patients and/or those shorter life expectancy because mean lifespan only reaches 7 9 years.1Sohn Furthermore, who scheduled TVR tend more comorbidities would put them at disproportionately high risk complications typically valves, such thromboembolic bleeding events.2Kaplan This clearly reflected baseline demographic characteristics colleagues,1Sohn where group were had Charlson comorbidity index worse cardiovascular profile. For any on topic, extensive correction confounding factors essential derive reliable conclusions from data. should be commended their efforts control using propensity score matching multivariate-adjusted analyses. Nonetheless, it considered unmeasured controlled still influence findings. In real-life setting, decision determined heart team’s assessment patient's Factors biological age likely influential than chronological decision-making process. instance, team decide 70-year-old patient young benefit most valve, whereas recommend an old age; 2 will obviously very different outlook mostly necessarily due factors. entity complex probably entirely measured (Figure 1). Thus, there might selection bias group, implies some increased simply rather Concluding preferred over all ages 54 65 years premature. type always carefully weighted context patient’s overall health status, age, individual factors, taking 1-size-fits-all approach.