Valve-related complications in elderly patients with biological and mechanical aortic valves

Background. Controversy still exists about the choice of aortic prosthesis in elderly patients. This study investigates valve- and anticoagulant-relat ed morbidity and mortality in elderly patients after aortic valve replaceme nt (AVR) with a biologic (BP) or mechanical prosthesis (MP). Methods. Between 1981 and 1995, 355 consecutive patients aged 70 years or o lder (mean, 74 +/- 4 years; range, 70 to 87 years) underwent isolated AVR. There were 222 (63%) replacements with an MP and 133 (37%) with a BP. Mean follow-up was 3.7 +/- 2.8 years (range, 3 months to 15 years), with a total follow-up of 1,214 patient-years. Results. Hospital mortality was 7.6% (27 of 355), decreasing to 4.6% in the last 3 years. There were 55 late deaths, 33 in patients with MF and 22 in those with BP. At 10 years there was no significant difference between MP a nd BP recipients in the actuarial estimates of survival (51% +/- 8% versus 33% +/- 13%), freedom from valve-related death (82% +/- 7% versus 72% +/- 1 2%), and freedom from thromboembolism (84% +/- 7% versus 94% +/- 3%). In co ntrast, 10-year freedom from anticoagul-antrelated hemorrhages was 74% +/- 8% for Mr and 99% +/- 1% for BP (p = 0.02). Only 1 structural deterioration occurred, in a patient with BP. Conclusions. Satisfactory early results can be obtained in elderly patients after AVR with both MP and BP. The comparable low late survival in the two groups was predominantly influenced by non-valve-related deaths. A higher incidence of anticoagulant-related hemorrhages limits the use of MP in elde rly patients. Thus, in this population, BP should be preferred not just on the basis of their expected longer durability, but mainly to avoid the risk of anticoagulant-related hemorrhages. (C) 1998 by The Society of Thoracic Surgeons.