title: Early and Late Outcomes of Aortic Valve Replacement Using Bioprosthetic Versus Mechanical Valve in Elderly Patients: A Propensity Analysis.
abstract: OBJECTIVE
  There is still controversy on the use of mechanical valves to treat elderly patients with a small aortic annulus who require aortic valve replacement (AVR). We compared our results in elderly patients who underwent AVR with a bioprosthetic or mechanical valve. Propensity matching adjusted for baseline differences in this study.
  
  
  METHODS
  Between January 2001 and July 2014, 277 patients aged ≥75 years old who underwent AVR were enrolled. Of 277 patients, 104 patients were selected using propensity score matching analysis. Out of this cohort, 52 patients underwent AVR with a bioprosthetic valve (B group) and the remainder AVR with a mechanical valve (M group).
  
  
  RESULTS
  There were no significant differences between the B and M groups in 30 days mortality (1.9% vs. 5.8%, p = 0.618). The incidence of patient-prosthesis mismatch (PPM) after AVR tended to be lower in the M group than in the B group. The overall survival rates in the B and M groups at eight years were 72.8% and 73.3%, respectively (p = 0.473). No significant differences between the two groups were observed in freedom from valve-related death, cardiac events, bleeding events, or stroke events.
  
  
  CONCLUSIONS
  AVR in elderly patients achieved relatively good short-term and long-term outcomes, and the incidence rates of valve-related complications after using a mechanical valve were low. In a selected population of elderly patients, a mechanical valve may be acceptable. doi: 10.1111/jocs.12719 (J Card Surg 2016;31:195-202).
authors.affiliation: Department of Cardiovascular Surgery, Tachikawa Medical Center, Nagaoka City, Nigata, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Okamoto
authors.affiliation: Department of Cardiovascular Surgery, Tachikawa Medical Center, Nagaoka City, Nigata, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Department of Cardiovascular Surgery, Tachikawa Medical Center, Nagaoka City, Nigata, Japan.
authors.forename: Shinpei
authors.initials: S
authors.lastname: Yoshii
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D015331:Cohort Studies; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D057216:Propensity Score; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome