Mechanical heart valves in septuagenarians.
OBJECTIVE
To report on the use of a third-generation bileaflet mechanical valve in septuagenarians, selected to receive a mechanical valve, as compared to (a) a younger cohort undergoing same valve implant (study 1) and to (b) a matched group of septuagenarians undergoing biological implant (study 2).


METHODS
The study was carried out in a tertiary regional hospital in South-West England. Study 1: Consecutive series of 567 patients undergoing Sorin Bileaflet (SB) mechanical valve implant (437 patients < 70 years; 130 patients >or= 70 years). Study 2: 113 septuagenarians undergoing biological implant matched on age, valve type, concomitant coronary surgery, and operative priority to the SB septuagenarian group. Main outcome measures included in-hospital mortality and morbidity and mid-term valve-related outcome.


RESULTS
Study 1: Septuagenarians were more likely to present with coronary disease, and to undergo coronary surgery (p < 0.01). In-hospital mortality was 2.8% and 2.3% (p = 0.79) and neurological complications 1.4% versus 3.8% (p = 0.026) in the younger and older groups, respectively. Valve-related mortality at two years was 1.8% (95%CI, 0.8% to 3.6%) and 4.8% (95% CI, 2.0% to 9.7%); cumulative three- year incidence of thromboembolic or major hemorrhagic event was 8.3% (95% CI, 5.7% to 12.0%) and 4.6% (95% CI, 1.7% to 12.4%) in the younger and older groups, respectively. Study 2: In-hospital mortality was 1.8% and 7.1% in the SB and biological groups, respectively (ratio 0.25; 95% CI, 0.05 to 1.18, p = 0.058). The incidence of acute renal failure was greater in the biological group (risk ratio 0.30; 95% CI, 0.09 to 0.98, p = 0.035). There was no difference in mid-term valve-related mortality between groups (hazard ratio 0.53; 95% CI, 0.18 to 1.52, p = 0.24).


CONCLUSIONS
The performance of SB valve in septuagenarians seems to be effective with no increased risk of in-hospital mortality, bleeding, or thromboembolic events.
Ascione
R
R
Bristol Heart Institute, University of Bristol, Bristol, UK. R.Ascione@bristol.ac.uk
Culliford
L
L
Rogers
C A
CA
Wild
J
J
Narajan
P
P
Angelini
G D
GD
D000368:Aged; D004696:Endocarditis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006470:Hemorrhage / Q000209:etiology*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013923:Thromboembolism / Q000209:etiology*; D016896:Treatment Outcome