title: Long-term safety and effectiveness of mechanical versus biologic aortic valve prostheses in older patients: results from the Society of Thoracic Surgeons Adult Cardiac Surgery National Database.
abstract: BACKGROUND
  There is a paucity of long-term data comparing biological versus mechanical aortic valve prostheses in older individuals.
  
  
  RESULTS
  We performed follow-up of patients aged 65 to 80 years undergoing aortic valve replacement with a biological (n=24 410) or mechanical (n=14 789) prosthesis from 1991 to 1999 at 605 centers within the Society of Thoracic Surgeons Adult Cardiac Surgery Database using Medicare inpatient claims (mean, 12.6 years; maximum, 17 years; minimum, 8 years), and outcomes were compared by propensity methods. Among Medicare-linked patients undergoing aortic valve replacement (mean age, 73 years), both reoperation (4.0%) and endocarditis (1.9%) were uncommon to 12 years; however, the risk for other adverse outcomes was high, including death (66.5%), stroke (14.1%), and bleeding (17.9%). Compared with those receiving a mechanical valve, patients given a bioprosthesis had a similar adjusted risk for death (hazard ratio, 1.04; 95% confidence interval, 1.01-1.07), higher risks for reoperation (hazard ratio, 2.55; 95% confidence interval, 2.14-3.03) and endocarditis (hazard ratio, 1.60; 95% confidence interval, 1.31-1.94), and lower risks for stroke (hazard ratio, 0.87; 95% confidence interval, 0.82-0.93) and bleeding (hazard ratio, 0.66; 95% confidence interval, 0.62-0.70). Although these results were generally consistent among patient subgroups, bioprosthesis patients aged 65 to 69 years had a substantially elevated 12-year absolute risk of reoperation (10.5%).
  
  
  CONCLUSIONS
  Among patients undergoing aortic valve replacement, long-term mortality rates were similar for those who received bioprosthetic versus mechanical valves. Bioprostheses were associated with a higher long-term risk of reoperation and endocarditis but a lower risk of stroke and hemorrhage. These risks varied as a function of a patient's age and comorbidities.
authors.affiliation: Duke Clinical Research Institute, 2400 Pratt St, Durham, NC 27705, USA. j.matthew.brennan@dm.duke.edu
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Brennan
authors.forename: Fred H
authors.initials: FH
authors.lastname: Edwards
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhao
authors.forename: Sean
authors.initials: S
authors.lastname: O'Brien
authors.forename: Michael E
authors.initials: ME
authors.lastname: Booth
authors.forename: Rachel S
authors.initials: RS
authors.lastname: Dokholyan
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis / Q000009:adverse effects / Q000706:statistics & numerical data*; D002309:Cardiology; D015897:Comorbidity; D016208:Databases, Factual; D004696:Endocarditis / Q000453:epidemiology; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000706:statistics & numerical data*; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk; D012955:Societies, Medical; D020521:Stroke / Q000453:epidemiology; D013903:Thoracic Surgery; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology