title: Long-Term Outcome of Prosthetic Valve Replacement in Japanese Patients Aged 65 Years or Older: Are Guidelines for Prosthetic Valve Selection Based on Overseas Data Appropriate for Japanese Patients?
abstract: BACKGROUND
  Based on the revised AHA/ACC guidelines, it might be necessary to take into consideration the average life expectancy of Japanese people and revise the Japanese guidelines accordingly. Accordingly, we performed the present study to compare the long-term outcome in patients aged 65 years or older who underwent prosthetic valve replacement at our hospital using mechanical valves or biological valves.
  
  
  METHODS
  We have performed valve replacement in 416 patients aged 65 years or older (mechanical: 157; biological: 244).
  
  
  RESULTS
  There was no significant difference between the mechanical and biological valve for the actuarial survival rate. As for the valve-related complication free rate, in the mechanical valve group, the rates were significantly higher for all patients, aortic valve replacement (AVR) patients, and mitral valve replacement (MVR) patients.
  
  
  CONCLUSIONS
  Following revision of the AHA/ACC guidelines for selection of prosthetic valves, it is necessary to investigate whether patients aged 60-70 represent the gray zone for selecting valves as in US and European guidelines, or whether a higher age is more appropriate in view of the longer average life expectancy in Japan. Accordingly, further evaluation of the long-term outcome for mechanical and biological valves in Japanese patients is needed to obtain evidence for preparation of original Japanese guidelines on prosthetic valve selection.
authors.affiliation: The Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Sezai
authors.forename: Shunji
authors.initials: S
authors.lastname: Osaka
authors.forename: Hiroko
authors.initials: H
authors.lastname: Yaoita
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Ishii
authors.forename: Munehito
authors.initials: M
authors.lastname: Arimoto
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Hata
authors.forename: Motomi
authors.initials: M
authors.lastname: Shiono
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D001705:Bioprosthesis / Q000592:standards; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000592:standards; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality / Q000592:standards; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008017:Life Expectancy / Q000208:ethnology; D008297:Male; D018579:Patient Selection; D017410:Practice Guidelines as Topic / Q000592:standards; D011474:Prosthesis Design; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome