Are older patients with mechanical heart valves at increased risk?

• Published in: The Annals of thoracic surgery Vol. 68; no. 6; pp. 2169 - 2172
• Main Authors: Masters, Roy G, Semelhago, Lloyd C, Pipe, Andrew L, Keon, Wilbert J
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.1999; Elsevier Science
• Subjects: Age Factors; Aged; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Aortic Valve - surgery; Biological and medical sciences; Heart Valve Prosthesis Implantation - adverse effects; Hemorrhage - chemically induced; Humans; Male; Medical sciences; Middle Aged; Mitral Valve - surgery; Prospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Thromboembolism - etiology; Warfarin - adverse effects; Warfarin - therapeutic use; Human; Warfarin; Prosthesis; Coumarine derivatives; Cardiovascular disease; Anticoagulant; Replacement; Vascular disease; Chemotherapy; Treatment; Cardiac valvular disease; Surgery; Risk factor; Complication; Thromboembolism; Elderly
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(99)00826-7

Background. Controversy exists regarding the use of mechanical valves in older patients. Many authorities believe that the use of anticoagulants in the elderly is associated with an increased risk of warfarin-related complications. Therefore, we compared the results with mechanical valves in older patients to a cohort of younger patients. Methods. Aortic (AVR) or mitral valve replacement (MVR) with a mechanical valve was performed in 1,245 consecutive patients who were followed prospectively. They were grouped by age (group 1, ≤ 65 years; group 2, > 65 years). The study groups consisted of AVR (group 1, 459 patients; group 2, 323 patients) MVR (group 1, 313 patients; group 2, 150 patients). Results. The average age for the groups was: AVR (group 1, 51 years; group 2, 70 years; p = 0.03) and MVR (group 1, 53 years; group 2, 70 years; p = 0.03). For AVR the incidence of thromboembolism was 0.050 (group 1) and 0.038 (group 2) (p = 0.37) and the actuarial freedom from thromboembolism was 83.0% ± 3.0% and 86.5% ± 1.0%, respectively (p = 0.13). The incidence of bleeding after AVR was 0.021 for group 1 and 0.028 for group 2 (p = 0.49). For MVR the incidence of thromboembolism was 0.059 for group 1 and 0.051 for group 2 (p = 0.75) and the actuarial freedom from thromboembolism was 78.8% ± 3.0% and 75.4% ± 8.7%, respectively (p = 0.71). The incidence of bleeding after MVR was 0.020 for group 1 and 0.027 for group 2 (p = 0.62). Conclusions. Mechanical valves perform well in selected older patients with no increased risk of bleeding or thromboembolism.