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The Annals of Thoracic Surgery, Vol 48, 173-184, Copyright © 1989 by The Society of Thoracic Surgeons
WR Jamieson, LH Burr, AI Munro, RT Miyagishima and AN Gerein
From 1975 to 1987, 1,127 elderly patients underwent 1,223 valve
replacements with the Carpentier-Edwards standard or supraannular porcine
bioprostheses in 1,147 operations. Of the total patient population seen
during these years, 33.5% receiving a standard porcine bioprosthesis and
48.6% receiving a supraannular bioprosthesis were 65 years of age or older.
Of this elderly patient population, 465 patients were between 65 and 69
years old; 618 patients, 70 and 79 years old; and 52 patients, 80 years old
and older. Aortic valve replacement was performed in 635 patients, mitral
valve replacement in 417 patients, tricuspid valve replacement in 2
patients, and multiple-valve replacement in 80 patients. The cumulative
follow-up was 3,957 patient- years. Early mortality was 9.5%: 7.3% for the
65- to 69-year-old group, 10.7% for the 70- to 79-year-old group, and 15.4%
for the group 80 years old and older. Late mortality was 5.5% per
patient-year: 4.2% per patient-year for the 65- to 69-year-old group, 6.3%
per patient-year for the 70- to 79-year-old group, and 14.1% per
patient-year for the group 80 years old and older. Valve-related causes
contributed to 7 early deaths and 33 late deaths. The overall patient
survival, including operative deaths, was 70.7% +/- 1.6% at 5 years and
47.8% +/- 3.7% at 10 and 12 years. The freedom from all valve-related
complications was 52.1% +/- 6.1% at 10 and 12 years. The overall rate of
valve-related complications was 5.0% per patient-year (fatal complications,
1.13% per patient-year). The overall rate of thromboembolism was 2.3% per
patient-year and the freedom from thromboembolism, 69.6% +/- 5.2% at 10 and
12 years. The freedom from structural valve deterioration was 80.8% +/-
8.1% at 10 and 12 years: 71.7% +/- 11.0% at 10 and 12 years for the 65- to
69-year-old group, 97.9% +/- 1.2% at 10 years for the 70- to 79-year-old
group, and 100% at 12 years for the group 80 years old and older. At 10 and
12 years, the freedom from valve-related death was 83.7% +/- 4.3% and the
freedom from reoperation, 73.3% +/- 8.6%. The freedom from valve-related
death, residual morbidity from thromboembolism and anticoagulant-related
hemorrhage, and reoperation was 61.7% +/- 7.0% at 10 and 12 years. The
clinical performance of porcine bioprostheses in the elderly patient
population has been excellent. The early mortality increases in patients 70
years old or older.(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
Cardiac valve replacement in the elderly: clinical performance of biological prostheses
Vancouver General Hospital, University of British Columbia, Canada.
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