CHOICE OF REPLACEMENT VALVE IN THE ELDERLY

Background and aims of the study: Little comparative information exist s an the outcome of valve replacement with bioprostheses or mechanical valves in the elderly. This study was carried out to make such a comp arison. Methods: Follow up data were examined from 219 patients aged g reater than or equal to 65 years who underwent aortic and/or mitral va lve replacement using bioprosthetic (n = 67) or mechanical valve (n = 152) between April 1979 and December 1993. The mean follow up periods were 6.3 +/- 2.8 years after bioprosthesis and 4.9 +/- 2.1 years after mechanical valve implantation. Results: Although the actuarial rate o f structural deterioration was higher in patients with bioprosthetic v alves than in those with mechanical valves (58% versus 100% freedom at 10 years after surgery, p <0.01), no such prosthesis-related differen ce was seen in the subgroup of patients aged greater than or equal to 70 (100% versus 100% at nine years, p = N.S.). The actuarial rate of m ajor bleeding was higher after mechanical valve implantation than afte r bioprosthetic valve placement (90% versus 100% freedom at 10 years, p <0.05); this lower rate with bioprosthetic valves was maintained in patients aged greater than or equal to 70 (78% versus 100% at nine yea rs, p <0.05), There were no significant differences in the incidences of thromboembolism and bacterial endocarditis between the two valve ty pes. Conclusions: Structural degeneration of bioprosthetic devices was a major problem in patients aged 65-70 years, but it was essentially negligible in those aged greater than or equal to 70 years. Anticoagul ant-related bleeding was a major problem with mechanical valves in bot h age groups,Therefore, for patients older than 70 years, valve replac ement with a bioprosthesis appears to be the method of choice.