title: Mechanical valve prosthesis is a valid option for aortic valve replacement in the elderly.
abstract: OBJECTIVE
  Thromboembolism and hemorrhage related to anticoagulation remain a major concern in elderly patients with mechanical valves. Clinical results following isolated aortic valve replacement (AVR) with tilting disk and bileaflet prostheses in patients aged over 70 years were analyzed and compared with results in patients aged <45 years.
  
  
  METHODS
  Between January 1980 and August 2002, 319 consecutive older patients (group A) and 497 young patients AVR. Preoperative clinical data, early and late mortality, valve-related complications and data related to anticoagulation status (including mean INR and mean interval between INR assays) were compared between groups.
  
  
  RESULTS
  Hospital mortality was lower in group B (3.4%) than in group A (10.7%; p <0.0001). Twelve-year actuarial survival was lower in older patients (54% in group A versus 78% in group B; p <0.001). The two groups showed similar 12-year actuarial freedom from hemorrhage (99.6% versus 99.5%; p = 0.69), endocarditis (99.6% versus 98.43%; p = 0.25) and perivalvular leak (99.6% versus 97.9%; p = 0.21). However, actuarial freedom from thromboembolism was lower in older patients (98.8% versus 99.7%; p = 0.041).
  
  
  CONCLUSIONS
  Despite lower rates of long-term mortality and thromboembolism (the latter because of advanced atherosclerosis) in group A, there were no differences in rates of other valve-related complications. Hence, older age cannot be considered a contraindication to implantation of mechanical valves in the aortic position.
authors.affiliation: Department of Cardio-Thoracic and Respiratory Sciences, Monaldi Hospital, Second University of Naples, Italy.
authors.forename: Marisa
authors.initials: M
authors.lastname: De Feo
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.forename: Attilio
authors.initials: A
authors.lastname: Renzulli
authors.forename: Rosario
authors.initials: R
authors.lastname: Gregorio
authors.forename: Mariano
authors.initials: M
authors.lastname: Vicchio
authors.forename: Nicola
authors.initials: N
authors.lastname: Vitale
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cotrufo
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011474:Prosthesis Design; D012307:Risk Factors; D013997:Time Factors