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Perezgrovas-Olaria et al. Vessel Plus 2023;7:10 https://dx.doi.org/10.20517/2574-1209.2022.54 Page 7 of 11

Figure 2. Competing risk analysis for follow-up mortality and reoperation among matched groups. bCVG: Biological composite valve
graft; mCVG: mechanical composite valve graft.

Overall, 89.8% of the 49 reoperations were valve-related (75% aortic valve replacements and 25%
transcatheter aortic valve replacements; 2 reoperations due to prosthetic valve endocarditis, 15 due to
prosthetic valve insufficiency, 20 due to prosthetic valve stenosis, and 7 due to double lesion of the
prosthetic valve), 6.1% graft-related (1 due to aortic graft infection and 2 due to anastomotic stricture), and
4.1% of patients required a redo Bentall-De Bono operation (both due to prosthetic valve endocarditis and
aortic graft infection). The four cases of prosthetic valve endocarditis and all the cases of prosthetic valve
stenosis occurred in patients with a bCVG. The median time to reoperation was 10.4 years (IQR 8.3-13.0).

Multivariable analyses
Older age (HR 1.06, 95%CI: [1.04-1.08], P < 0.001), COPD (HR 1.63, 95%CI: [1.01-2.64], P = 0.04),
preoperative renal dysfunction (HR 3.08, 95%CI: [1.98-4.78], P < 0.001), NYHA Class III/IV (HR 1.48,
95%CI: [1.04-2.10], P = 0.03), and mCVG (HR 2.15, 95%CI: [1.42-3.26], P < 0.001) were associated with
higher risk of follow-up mortality.

Older age (HR 0.96, 95%CI: [0.94-0.98], P < 0.001), male sex (HR 0.45, 95%CI: [0.22-0.94], P = 0.03), and
mCVG (HR 0.02, 95%CI: [0.01-0.10], P < 0.001) were inversely associated with the risk of reoperation. A
summary of multivariable analyses is provided in Table 4.

Propensity-matched analysis
After PSM, two groups of 263 patients were identified. Balance was achieved based on SMD for baseline
characteristics [Table 5]. No difference in in-hospital outcomes was found between bCVG and mCVG
[Table 6]. Kaplan Meier estimates showed higher follow-up mortality in the mCVG group (24.7% vs. 15.7%,
P < 0.001; Figure 2) at 10 years. Ten-year reoperation was higher in the bCVG group (7.4% vs. 1.1%,
P < 0.001; Figure 2).