Cardiac valve replacement with mechanical prostheses in patients aged 65 years and over.
OBJECTIVE
Recent data regarding the performance of mechanical prostheses in patients aged > or =65 years are scant. Hence, the outcome of mechanical prosthesis implantation in this age group has been retrospectively evaluated.


METHODS
Between January 1990 and October 2002, 253 patients (163 males, 90 females) aged > or =65 years (mean age 68.2 years) underwent aortic valve replacement (AVR) and/or mitral valve replacement (MVR) at the authors' institution.


RESULTS
Among the patients, 94 (37.2%) had MVR, 137 (54.1%) had AVR, and 22 (8.7%) had MVR+AVR. In total, 99 patients (39.1%) had concomitant coronary artery bypass grafting (CABG). The early mortality rate was 11.1%; that for patients aged > or =70 years was greater than that for patients aged 65-69 years (14.5% versus 9.6%, p <0.001). The overall actuarial survival was 91.3 +/- 2.4% at 5 years, 81.1 +/- 4.1% at 8 years, and 73.8 +/- 6.3% at 10 years. Actuarial survival for patients with isolated AVR and MVR at 10 years was 84.7 +/- 6.0% and 61.4 +/- 18.8%, respectively. Actuarial survival at 10 years for patients with isolated valve replacement was 76.1 +/- 8.1%, and 68.7 +/- 10.2% for patients with concomitant CABG (p = 0.680). Actuarial survival at 10 years was 81.3 +/- 6.9% for patients aged 65-69 years, and 50.3 +/- 11.0% for patients aged > or =70 years (p = 0.001). Freedom from a major thromboembolic event was 99.4 +/- 0.7% at five years and 86.3 +/- 6.0% at 10 years, while freedom from hemorrhage was 90.4 +/- 2.6% and 70.3 +/- 6.8%, respectively.


CONCLUSIONS
Mechanical prostheses can be used in patients aged > or =65 years, with favorable results. However, on the basis of the present findings, patients aged > or =70 years have a reduced early and late survival.
Aksöyek
Aysen
A
Cardiovascular Surgery Clinic at Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey. aaksoyek@yahoo.com
Ulus
A Tulga
AT
Tütün
Ufuk
U
Budak
Baran
B
Parlar
Aihsan
A
Korkmaz
Kemal
K
Colak
Abdullah
A
Katircioglu
S Fehmi
SF
D000368:Aged; D001021:Aortic Valve / Q000473:pathology* / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008943:Mitral Valve / Q000473:pathology* / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey