Aortic Valve Selection in the Elderly Patient

• Published in: The Annals of thoracic surgery Vol. 46; no. 3; pp. 270 - 277
• Main Authors: Borkon, A. Michael, Soule, Lisa M., Baughman, Kenneth L., Baumgartner, William A., Gardner, Timothy J., Watkins, Levi, Gott, Vincent L., Hall, Kimberlee A., Reitz, Bruce A.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.09.1988; Elsevier Science
• Subjects: Aged; Anticoagulants - adverse effects; Aortic Valve; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Biological and medical sciences; Bioprosthesis - adverse effects; Cardiology. Vascular system; Central Nervous System Diseases - etiology; Endocardial and cardiac valvular diseases; Endocarditis - etiology; Female; Follow-Up Studies; Heart; Heart Valve Prosthesis - adverse effects; Hemorrhage - chemically induced; Humans; Male; Medical sciences; Postoperative Complications - etiology; Postoperative Complications - mortality; Prosthesis Failure; Thromboembolism - etiology; Human; Cardiac valvular disease; Prosthesis; Surgery; Mortality; Cardiovascular disease; Replacement; Heterotransplantation; Aortic valve; Elderly; Comparative study; Morbidity
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(10)65924-3

To determine the influence of valve selection on valve-related morbidity and mortality and patient survival, comparative long-term performance characteristics of mechanical (N = 68) and bioprosthetic (N = 73) heart valves were analyzed for 141 patients more than 70 years old who underwent isolated aortic valve replacement between 1970 and 1985. Cumulative patient follow-up was 491 patient-years (average, 4.3 years per patient). Hospital mortality was 18% and 19% for patients with mechanical valves and bioprosthetic valves, respectively. Survival at 5 years was 61 ± 7% (± the standard error) and 67 ± 10% for recipients of mechanical valves and bioprosthetic valves, respectively. Male sex ( p = 0.014) and urgency of operation ( p = 0.006) were independent risk factors for hospital mortality. Atrial fibrillation increased valve-related mortality ( p = 0.01). No patient required reoperation or experienced structural valve failure. While anticoagulant-related hemorrhage was increased in recipients of mechanical valves (9.2 ± 2.1%/patient-year) compared with recipients of bioprosthetic valves (2.3 ± 1.1%/patient-year), it did not result in a death or lead to permanent disability. There was no difference in freedom from any valve-related complication at 5 years. However, when all morbid events are considered, recipients of bioprosthetic valves experienced fewer valve-related complications than patients receiving mechanical valves (10.7 ± 2.3%/patient-year versus 17.6 ± 2.5%/patient-year, respectively; p < 0.05). The reduced incidence of anticoagulant-related hemorrhage and the infrequent need for warfarin sodium anticoagulation favor selection of a bioprosthetic heart valve in patients older than 70 years.