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Long-term outcome after biologic versus mechanical aortic valve replacement in 841 patients
D S Peterseim1, Y Y Cen, S Cheruvu
1Departments of Surgery and Medicine, Duke University Medical Center, Durham NC, USA.
The Journal of Thoracic and Cardiovascular Surgery
|April 30, 1999
Summary
For aortic valve replacement, mechanical valves suit younger patients (<65 years) with good life expectancy. Biologic valves are better for older patients (>65 years) or those with comorbidities like renal disease or low ejection fraction.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
Background:
- Aortic valve replacement (AVR) involves choosing between mechanical and biologic prostheses.
- Optimizing prosthesis selection is crucial for long-term patient outcomes.
Purpose of the Study:
- To optimize selection criteria for biologic versus mechanical valve prostheses in AVR.
- To compare the long-term efficacy and safety of Carpentier-Edwards (biologic) and St Jude Medical (mechanical) prostheses.
Main Methods:
- Retrospective analysis of 841 patients undergoing isolated, first-time AVR.
- Comparison of Carpentier-Edwards (n=429) and St Jude Medical (n=412) prostheses.
- Analysis of 10-year survival, reoperation rates, thromboembolism, hemorrhage, and perivalvular leak.
Main Results:
- No significant difference in 10-year survival between valve types (P=.4).
- Mechanical valves (St Jude Medical) showed better 10-year survival-free from morbidity in patients <65 years.
- Biologic valves (Carpentier-Edwards) showed better 10-year survival-free from morbidity in patients >65 years.
- Lower hemorrhage rates with Carpentier-Edwards; higher perivalvular leak with St Jude Medical.
- Younger age and Carpentier-Edwards prosthesis predicted reoperation.
Conclusions:
- Mechanical prostheses are recommended for patients <65 years with ≥10-year life expectancy.
- Bioprostheses are recommended for patients >65 years or with comorbidities (renal disease, lung disease, low ejection fraction, coronary disease, or <10-year life expectancy).