Valve replacement in the elderly. Is the mechanical valve a good alternative?

Area of Science:

• Cardiology
• Biomedical Engineering
• Geriatric Medicine

Background:

• The optimal choice of prosthesis for elderly patients undergoing valve replacement remains a subject of debate.
• Mechanical prostheses, such as Medtronic Hall and St. Jude Medical valves, are frequently considered for this patient population.

Purpose of the Study:

• To evaluate the performance and complication rates of mechanical heart valves in patients aged 65 years and older.
• To compare outcomes in elderly patients with those of younger patients undergoing similar procedures.

Main Methods:

• A retrospective review of 213 patients (≥65 years) who received mechanical valve replacements (mitral, aortic, or double) between 1980 and 1985.
• Analysis of early and late mortality, reoperation rates, and specific complications including thrombotic obstruction, thromboembolism, and hemorrhage.
• Actuarial survival and freedom from complications were calculated and compared to a younger patient cohort.

Main Results:

• Early mortality rates varied by valve type, with double valve replacements showing the highest (21.1%).
• Late mortality was 8.1% per patient-year, with only 1.3% being valve-related; noncardiac causes were frequent.
• Rates of reoperation, thrombotic obstruction, thromboembolism, and hemorrhage were similar to younger patients, with global survival at 58% +/- 4%.

Conclusions:

• Mechanical prostheses perform well in elderly patients, with complication rates comparable to younger individuals.
• The study did not find an increased incidence of thromboembolic or hemorrhagic events in the elderly cohort.
• Mechanical valves are a viable option for elderly patients requiring valve replacement, with acceptable long-term outcomes.