Performance of bioprostheses and mechanical prostheses in age group 61-70 years.
OBJECTIVE
The performance of bioprostheses (BP) and mechanical prostheses (MP) from valve-related composites of complications and combined major thromboembolism and hemorrhage were considered in order to facilitate decision-making for the patient age group of 61-70 years.


METHODS
The aortic valve replacement (AVR) population (BP, n = 619; MP, n = 303) was differentiated by age, concomitant coronary artery bypass, diabetes mellitus, chronic obstructive pulmonary disease (COPD) and preoperative renal failure. The mitral valve replacement (MVR) population (BP, n = 353; MP, n = 312) was differentiated by valve type, age, concomitant coronary artery bypass, ejection fraction, NYHA and preoperative renal failure.


RESULTS
Actual freedom from reoperation for AVR was 92.1 +/- 1.5% for BP and 98.7 +/- 6.6% for MP, and for MVR was 74.5 +/- 2.6% for BP and 93.8 +/- 2.2% (12 years) for MP. Actual freedom from major thromboembolism and hemorrhage for AVR was 85.1 +/- 1.7% for BP and 76.9 +/- 3.6% for MP, and for MVR was 82.7 +/- 2.4% for BP and 76.7 +/- 3.8% (12 years) for MP. Linearized rates were undifferentiated for major thromboembolism. The hemorrhage rate for AVR-BP was 0.55%/pt-yr and for AVR-MP was 2.3%/pt-yr (p < 0.0001); for MVR-BP, the rate was 0.69%/pt-yr and for MVR-MP was 1.85%/pt-yr (p = 0.0011). The only predictor of AVR reoperation was age, and predictors for MVR reoperation were prosthesis type and follow up NYHA class. Predictors of AVR major thromboembolism and hemorrhage were prosthesis type, age, diabetes mellitus and COPD. There were no predictors of MVR major thromboembolism and hemorrhage.


CONCLUSIONS
For the age group of 61-70 years, MP are recommended for MVR to protect from BP reoperation, whilst for AVR BP are recommended to protect from anticoagulant hemorrhage. Freedom from reoperation for AVR was undifferentiated for BP and MP at 12-15 years.
Prasongsukarn
Kriengchai
K
University of British Columbia, Vancouver, Canada.
Jamieson
W R Eric
WR
Lichtenstein
Samuel V
SV
D000367:Age Factors; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D019992:Databases as Topic; D048909:Diabetes Complications; D005260:Female; D006349:Heart Valve Diseases / Q000145:classification / Q000401:mortality / Q000601:surgery; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011474:Prosthesis Design; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013923:Thromboembolism / Q000209:etiology