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Mariano Vicchio
Alessandro Della Corte
Marisa De Feo
Giuseppe Santarpino
Luca S. De Santo
Gianpaolo Romano
Giuseppe Caianiello
Michelangelo Scardone
Maurizio Cotrufo
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Ann Thorac Surg 2007;84:459-465
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Quality of Life After Implantation of Bileaflet Prostheses in Elderly Patients: An Anticoagulation Work Group Experience

Mariano Vicchio, MDa,*, Alessandro Della Corte, MDa, Marisa De Feo, MD, PhDa, Giuseppe Santarpino, MDa, Luca S. De Santo, MDa, Gianpaolo Romano, MDb, Giuseppe Caianiello, MDb, Michelangelo Scardone, MDb, Maurizio Cotrufo, MDa

a Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
b Department of Cardiovascular Surgery and Transplants, V. Monaldi Hospital, Naples, Italy

Accepted for publication April 16, 2007.

* Address correspondence to Dr Vicchio, Via Cassano 150, Naples, 80144, Italy (Email: marianovicchio{at}libero.it).

Background: The aim of the study was to examine our experience with the implant of bileaflet mechanical prostheses and with a centralized management of anticoagulation and the related risks in patients aged older than 70 years, focusing on the resulting expectancy and quality of life.

Methods: Between January 1988 and January 2005, 681 consecutive patients older than 70 years (mean age, 73 ± 3.3 years) underwent bileaflet prostheses implantation in an isolated procedure (77%) or concomitant with other procedures (23%). Data were retrospectively collected, and follow-up was conducted by mean of outpatient chart review and outpatient clinic controls. Follow-up included assessment of perceived quality of life through the Medical Outcomes Trust Short Form 36-Item Health Survey tool (SF-36). The scores obtained by the patients were compared with those of the Italian general population matched for age and sex.

Results: Hospital mortality was 11.8%, and 74 late deaths (12.3%) occurred. Mean follow-up was 4.38 ± 2.85 years. Actuarial survival was 85.2% ± 0.014% at 1 year, 77.9% ± 0.017% at 5 years, 74.2% ± 0.02% at 10 years, and 71.8% ± 0.031% at 15 years. The mean international normalized ratio variability was 4.5% ± 1.2%. Freedom from bleeding was 98.7% ± 0.005% at 5 years and 98.3% ± 0.007% at 10 and 15 years. Freedom from thromboembolism was 99.1% ± 0.004% at 5 years, and 98.3% ± 0.007% at 10 and 15 years. The mean SF-36 scores in the study patients were significantly higher than those of the general population matched for age and sex (p < 0.001 in all domains).

Conclusions: Septuagenarian patients receiving mechanical valve prostheses did not experience increased rates of anticoagulation-related complications and perceived a satisfactory quality of life.


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