TY - JOUR
T1 - Aortic Valve Selection in the Elderly Patient
AU - Borkon, A. Michael
AU - Soule, Lisa M.
AU - Baughman, Kenneth L.
AU - Baumgartner, William A.
AU - Gardner, Timothy J.
AU - Watkins, Levi
AU - Gott, Vincent L.
AU - Hall, Kimberlee A.
AU - Reitz, Bruce A.
PY - 1988
Y1 - 1988
N2 - 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.
AB - 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.
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U2 - 10.1016/S0003-4975(10)65924-3
DO - 10.1016/S0003-4975(10)65924-3
M3 - Article
C2 - 3415376
AN - SCOPUS:0023821205
SN - 0003-4975
VL - 46
SP - 270
EP - 277
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 3
ER -