Mid term outcome and quality of life after aortic valve replacement in elderly people: mechanical versus stentless biological valves.
OBJECTIVE
To assess the benefit for patients older than 65 years of aortic valve replacement with stentless biological heart valves in comparison with mechanical valves.


METHODS
Multiple regression analysis of a retrospective follow up study.


METHODS
Single cardiothoracic centre.


METHODS
Between 1996 and 2001, 392 patients with a mean age of 74 years underwent aortic valve replacement with stentless Freestyle bioprostheses or mechanical St Jude Medical prostheses.


METHODS
Operative mortality and morbidity, postoperative morbid events, mid term survival, and New York Heart Association (NYHA) class improvement, and quality of life.


RESULTS
No significant differences were found between patients receiving stentless biological valves and patients receiving mechanical prostheses. However, analysis of subgroups showed that patients older than 75 years with mechanical valves had an increased risk of major bleeding events (p = 0.007). Patients requiring anticoagulation by means of coumarin had a twofold increased risk of an impaired emotional reaction (p = 0.052). However, for patients who received a mechanical valve for severe combined aortic valve disease a survival advantage (p = 0.045) and a decreased risk of prolonged ventilation (p = 0.001) was observed. On the other hand, patients receiving a stentless bioprosthesis had an increased risk of a prolonged stay in intensive care (p = 0.04) and stroke (p = 0.01) if they had severely reduced cardiac function (NYHA class IV).


CONCLUSIONS
Elderly people receiving stentless bioprostheses benefit emotionally because of the avoidance of coumarin. However, in patients with severe hypertrophied ventricles and extraordinary calcifications, stentless bioprostheses should be chosen with caution.
Florath
I
I
Herzzentrum Lahr/Baden, Lahr, Germany. ines.florath@heart-lahr.com
Albert
A
A
Rosendahl
U
U
Alexander
T
T
Ennker
I C
IC
Ennker
J
J
D000368:Aged; D001021:Aortic Valve; D001705:Bioprosthesis; D004696:Endocarditis / Q000209:etiology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000401:mortality; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome