PORCINE BIOPROSTHESES IN THE ELDERLY - CLINICAL-PERFORMANCE BY AGE-GROUPS AND VALVE POSITIONS

Porcine bioprostheses have been recommended and used for cardiac valve replacement in the elderly. A review of 1,984 patients with 2,042 ope rations, performed between 1975 and 1992, has afforded a detailed eval uation of clinical performance by valve positions and age groups withi n the elderly population. The numbers of operations performed by age g roups were 65 to 69 years, 719; 70 to 74 years, 745; 75 to 79 years, 4 31; 80 to 84 years, 119; and 85 years or older, 28. The early mortalit y rate overall was 9.5% (195 patients), range 6.9% to 17.8% by age gro ups (p < 0.05), and 11.9% with concomitant procedures and 7.6% without (p < 0.05). The total cumulative follow-up was 10,060 patient-years ( mean, 4.9 years). The late mortality rate was 7.0%/patient-year (for a ge groups, 5.8% to 13.4%/patient-year) (p = not significant). The pati ent survival at 15 years ranged from 25% +/- 4% for 65 to 69 years to 9% +/- 5% for 75 to 79 years (p < 0.05). The freedom from valve-relate d complications and composites at 10 years revealed differences (p < 0 .05) by age groups only for structural valve deterioration: 85% +/- 2% for 65 to 69 years versus 98% +/- 2% for 80 to 84 years. The overall freedom from structural valve deterioration at 10 years for aortic val ve replacement was 98% +/- 1%; for mitral valve replacement, 79% +/- 3 %; and for multiple replacement, 86% +/- 7% (p < 0.05, aortic valve re placement > mitral valve replacement). The freedom from structural val ve deterioration by valve positions between age groups was different ( p < 0.05). The freedom from structural valve deterioration for aortic valve replacement at 10 years was 95% +/- 2% for 65 to 69 years and 99 % +/- 1% for 70 to 74 years. The freedom from structural valve deterio ration for mitral valve replacement at 10 years was 70% +/- 5% for 65 to 69 years, 90% +/- 4% for 70 to 74 years, and 94% +/- 6% for 75 to 7 9 years. The freedom from valve-related reoperation paralleled that fo r structural valve deterioration. The freedom from overall complicatio ns (morbidity and mortality) at 10 years was 70% +/- 2% for aortic val ve replacement, 54% +/- 4% for mitral valve replacement, and 49% +/- 9 % for multiple replacement (p < 0.05). Porcine bioprostheses should st ill be implanted for aortic valve replacement in the elderly 65 years of age and older and for mitral valve replacement in patients 70 years of age and older. The incidence of valve-related complications remain s low, and long-term survival is excellent.