Long-term outcome after biologic versus mechanical aortic valve replacement in 841 patients

Objective: The purpose of this study was to optimize selection criteria of biologic versus mechanical valve prostheses for aortic valve replacement. M ethods: Retrospective analysis was performed for 841 patients undergoing is olated, first-time aortic valve replacement with Carpentier-Edwards (n = 42 9) or St Jude Medical (n = 412) prostheses. Results: Patients with Carpenti er-Edwards and St Jude Medical valves had similar characteristics. Ten-gear survival was similar in each group (Carpentier-Edwards 54% +/- 3% versus S t Jude Medical 50% +/- 6%; P =.4), Independent predictors of worse survival were older age, renal or lung disease, ejection fraction less than 40%, di abetes, and coronary disease. Carpentier-Edwards versus St Jude Medical pro stheses did not affect survival (P =.4). Independent predictors of aortic v alve reoperation were younger age and Carpentier-Edwards prosthesis. The li nearized rates of thromboembolism were similar, but the linearized rate of hemorrhage was lower with Carpentier-Edwards prostheses (P <.01), Perivalvu lar leak within 6 months of operation was more likely with St Jude Medical than with Carpentier-Edwards prostheses (P =.02). Estimated 10-year surviva l free from valve-related morbidity was better for the St Jude Medical valv e in patients aged less than 65 Sears and was better for the Carpentier-Edw ards valve in patients aged more than 65 years. Patients with renal disease , lung disease tin patients more than age 60 years), ejection fraction less than 40%, or coronary disease had a life expectancy of less than 10 years. Conclusions: For first-time, isolated aortic valve replacement, mechanical prostheses should be consider ed in patients under age 65 years with a lif e expectancy of at least 10 years. Bioprostheses should be considered in pa tients over age 65 years or with lung disease tin patients over age 60 Sear s), renal disease, coronary disease, ejection fraction less than 40%, or a life expectancy less than 10 years.