Mechanical valve prosthesis is a valid option for aortic valve replacement in the elderly

Area of Science:

• Cardiovascular Surgery
• Geriatric Medicine
• Biomaterials Science

Background:

• Anticoagulation complications (thromboembolism, hemorrhage) are significant concerns for elderly patients with mechanical heart valves.
• Aortic valve replacement (AVR) outcomes in elderly patients require careful evaluation.

Purpose of the Study:

• To compare clinical outcomes of isolated AVR using mechanical valves in patients over 70 years old versus those under 45 years old.
• To assess the safety and efficacy of mechanical aortic valves in elderly populations.

Main Methods:

• Retrospective analysis of 319 older patients (group A, >70 years) and 497 younger patients (group B, <45 years) undergoing AVR between 1980 and 2002.
• Comparison of preoperative data, mortality, valve-related complications, and anticoagulation status (mean INR, assay intervals) between the two groups.

Main Results:

• Hospital mortality was significantly higher in older patients (10.7%) compared to younger patients (3.4%).
• Twelve-year survival was lower in older patients (54%) versus younger patients (78%).
• Older patients had a lower actuarial freedom from thromboembolism (98.8% vs. 99.7%), but similar rates of hemorrhage, endocarditis, and perivalvular leak.

Conclusions:

• Despite increased risks of mortality and thromboembolism in older patients, other valve-related complications were comparable.
• Older age should not preclude the implantation of mechanical valves in the aortic position.
• Mechanical aortic valves demonstrate acceptable long-term outcomes in carefully selected elderly patients.