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Bioprosthetic versus mechanical prostheses for aortic valve replacement in the elderly
E A Davis1, P S Greene, D E Cameron
1Johns Hopkins University School of Medicine, Baltimore, Md, USA.
Circulation
|November 1, 1996
Summary
For elderly patients undergoing aortic valve replacement (AVR), both mechanical and bioprosthetic valves offer similar risks and outcomes. Mechanical valves may be underused in this population due to a low risk of bleeding with anticoagulation and a higher risk of reoperation with bioprosthetic valves.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Biomaterials Science
Background:
- Bioprosthetic valves are often preferred in elderly patients to avoid anticoagulation.
- Increasing life expectancy in the elderly necessitates re-evaluation of valve choice.
- Age-specific risks of anticoagulation in this demographic are not well-established.
Purpose of the Study:
- To compare valve- and anticoagulation-related morbidity in elderly patients after aortic valve replacement (AVR).
- To evaluate the safety and efficacy of bioprosthetic versus mechanical valves in patients aged 70 years and older.
Main Methods:
- Retrospective analysis of 211 patients (age ≥70) undergoing isolated AVR between 1980 and 1994.
- Comparison of outcomes between patients receiving bioprosthetic (n=145) and mechanical (n=66) valves.
- Follow-up data collected for 98% of hospital survivors.
Main Results:
- Operative mortality was 6.6%; 3- and 5-year survival rates were 75.3% and 64.6%, respectively.
- No significant difference in operative or late mortality between valve groups.
- Similar rates of thromboembolism, endocarditis, and anticoagulant-related hemorrhage; however, prosthetic failure occurred in 2% of bioprosthetic valves, necessitating reoperation in 4 patients.
Conclusions:
- Elderly patients can receive either mechanical or bioprosthetic valves with similar risks, provided no contraindications to anticoagulation exist.
- Anticoagulation-related hemorrhage risk is low in this elderly cohort.
- The significant risk of reoperation with bioprosthetic valves suggests mechanical valves may be underutilized in the elderly population.