Are older patients with mechanical heart valves at increased risk?

Background. Controversy exists regarding the use of mechanical valves in ol der patients. Many authorities believe that the use of anticoagulants in th e elderly is associated with an increased risk of warfarin-related complica tions. Therefore, we compared the results with mechanical valves in older p atients to a cohort of younger patients. Methods. Aortic (AVR) or mitral valve replacement (MVR) with a mechanical v alve was performed in 1,245 consecutive patients who were followed prospect ively. They were grouped by age (group 1, less than or equal to 65 years; g roup 2, > 65 years). The study groups consisted of AVR (group 1, 459 patien ts; group 2, 323 patients) MVR (group 1, 313 patients; group 2, 150 patient s). Results. The average age for the groups was: AVR (group 1, 51 years; group 2, 70 years; p = 0.03) and MVR (group 1, 53 years; group 2, 70 years; p = 0 .03). For AVR the incidence of thromboembolism was 0.050 (group 1) and 0.03 8 (group 2) (p = 0.37) and the actuarial freedom from thromboembolism was 8 3.0% +/- 3.0% and 86.5% +/- 1.0%, respectively (p = 0.13). The incidence of bleeding after AVR was 0.021 for group 1 and 0.028 for group 2 (p = 0.49). For MVR the incidence of thromboembolism was 0.059 for group 1 and 0.051 f or group 2 (p = 0.75) and the actuarial freedom from thromboembolism was 78 .8% +/- 3.0% and 75.4% +/- 8.7%, respectively (p = 0.71). The incidence of bleeding after MVR was 0.020 for group 1 and 0.027 for group 2 (p = 0.62). Conclusions. Mechanical valves perform well in selected older patients with no increased risk of bleeding or thromboembolism. (C) 1999 by The Society of Thoracic Surgeons.