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The Annals of Thoracic Surgery, Vol 46, 270-277, Copyright © 1988 by The Society of Thoracic Surgeons
AM Borkon, LM Soule, KL Baughman, WA Baumgartner, TJ Gardner, L Watkins, VL Gott, KA Hall and BA Reitz
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
less than 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.
ARTICLES
Aortic valve selection in the elderly patient
Division of Cardiac Surgery and Cardiology, Johns Hopkins Hospital, Baltimore, MD.
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