Aortic valve replacement with mechanical and biologic prostheses in middle-aged patients

Background. Mechanical prostheses are used in young patients and bioprosthe ses in the elderly because of the higher rate of structural failure of biop rostheses. The objective of the present study was to compare results after aortic valve replacement with mechanical (CarboMedics) and biologic (Carpen tier-Edwards pericardial) in middle-aged patients. Methods. Five hundred twenty-one patients, aged between 55 and 65 years, wh o underwent aortic valve replacement with mechanical (n = 363) or biologic (n = 158) prostheses were reviewed. Results. The 10-year actuarial survival rate averaged 66% +/- 6% in patient s implanted with mechanical valves compared with 75% +/- 4% in patients imp lanted with biologic valves (p = 0.2). The 10-year freedom rate from thromb oembolism, hemorrhage, and endocarditis averaged 92% +/- 7%, 97% +/- 2%, an d 99% +/- 1%, respectively, in patients with mechanical valves compared wit h 91% +/- 3% (p = 0.03), 99% +/- 1% (p = 0.4), and 95% +/- 2% (p = 0.01), r espectively, in those with biologic valves. The 10-year freedom rate from a ll valve-related complications averaged 90% +/- 7% acid 83% +/- 4%, respect ively (p = 0.01). Conclusions. The freedom rate from all valve-related complications was high er among patients with mechanical valves compared with biologic valves 10 y ears after aortic valve replacement in middle-aged patients. (C) 2001 by Th e Society of Thoracic Surgeons.