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Ann Thorac Surg 1988;46:270-277
© 1988 The Society of Thoracic Surgeons

Articles

Aortic Valve Selection in the Elderly Patient

A. Michael Borkon, M.D.*, Lisa M. Soule, M.A., Kenneth L. Baughman, M.D., William A. Baumgartner, M.D., Timothy J. Gardner, M.D., Levi Watkins, M.D., Vincent L. Gott, M.D., Kimberlee A. Hall, B.S., Bruce A. Reitz, M.D.

From the Division of Cardiac Surgery and Cardiology, The Johns Hopkins Hospital, Baltimore, MD

* Address reprint requests to Dr. Borkon, Medical Plaza, Suite 50-II, 4320 Wornall Rd, Kansas City, MO 64111.

To determine the influence of valve selection on valve-related morbidity and mortality and patient survival, comparative long-term performance characteristics of mechanical (N = 68) and bioprosthetic (N = 73) heart valves were analyzed for 141 patients more than 70 years old who underwent isolated aortic valve replacement between 1970 and 1985. Cumulative patient follow-up was 491 patient-years (average, 4.3 years per patient). Hospital mortality was 18% and 19% for patients with mechanical valves and bioprosthetic valves, respectively. Survival at 5 years was 61 ± 7% (± the standard error) and 67 ± 10% for recipients of mechanical valves and bioprosthetic valves, respectively. Male sex (p = 0.014) and urgency of operation (p = 0.006) were independent risk factors for hospital mortality. Atrial fibrillation increased valve-related mortality (p = 0.01). No patient required reoperation or experienced structural valve failure. While anticoagulant-related hemorrhage was increased in recipients of mechanical valves (9.2 ± 2.1%/patient-year) compared with recipients of bioprosthetic valves (2.3 ± 1.1%/patient-year), it did not result in a death or lead to permanent disability. There was no difference in freedom from any valve-related complication at 5 years. However, when all morbid events are considered, recipients of bioprosthetic valves experienced fewer valve-related complications than patients receiving mechanical valves (10.7 ± 2.3%/patient-year versus 17.6 ± 2.5%/patient-year, respectively; p < 0.05). The reduced incidence of anticoagulant-related hemorrhage and the infrequent need for warfarin sodium anticoagulation favor selection of a bioprosthetic heart valve in patients older than 70 years.




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