The fate of bioprostheses in middle-aged patients: the Japanese experience.
OBJECTIVE
Although the trend of bioprosthesis use has been evaluated extensively, the durability of currently available bioprostheses has not been determined in middle-aged patients. The study aim was to determine the long-term fate of bioprostheses implanted in patients aged < 60 years.


METHODS
Valve implantation data were collected from 43 centers in Japan. The data included patient age at implantation, type of valve, implant position, follow up period, and cause of reoperation including structural valve deterioration (SVD) and non-SVD. Between 1975 and 2005, a total of 697 bioprostheses was implanted in the mitral position, and 247 in the aortic position. The mean follow up period was 9.2 years. Rates of freedom from SVD and reoperation were determined using an actuarial method.


RESULTS
The mean age at implantation was 45 +/- 10.9 years. The 15-year freedom from SVD was 39% for those with valves implanted in the aortic position, and 27% in the mitral position (p = 0.004). For the same period, the actuarial freedom from reoperation was 31% for valves in the aortic position, and 24% in the mitral position (p = 0.178). The difference in actuarial freedom from SVD was not significant between age groups in the mitral position. However, there were differences in actuarial freedom from SVD in the aortic position for patients aged < 10 years when compared to the other age groups (p < 0.001). New-generation valves showed better long-term durability than older valves (p = 0.05).


CONCLUSIONS
The long-term freedom from SVD in middle-aged patients was unfavorable for bioprostheses implanted in the aortic and mitral positions. Middle-aged patients must be made aware that reoperation will be necessary; consequently, the choice of bioprosthesis should be dictated by patient-surgeon preference.
National Cardiovascular Center, Department of Cardiovascular Surgery, 5-7-1, Fujishirodai, Suita, Osaka, Japan. hirtanak@hsp.ncvc.go.jp
Hiroshi
H
Tanaka
Yutaka
Y
Okita
Hitoshi
H
Kasegawa
Shinichi
S
Takamoto
Koichi
K
Tabayashi
Toshikatsu
T
Yagihara
Yuichi
Y
Ueda
Shigeaki
S
Aoyagi
Masashi
M
Komeda
Kiyoyuki
K
Eishi
Hiromi
H
Kurosawa
D000328:Adult; D001705:Bioprosthesis; D019544:Equipment Failure Analysis; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007564:Japan; D008875:Middle Aged; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome