Aortic valve replacement in patients aged 50 to 70 years: Improved outcome with mechanical versus biologic prostheses

被引:128
作者
Brown, Morgan L. [1 ]
Schaff, Hartzell V. [1 ]
Lahr, Brian D. [2 ]
Mullany, Charles J. [1 ]
Sundt, Thoralf M. [1 ]
Dearani, Joseph A. [1 ]
McGregor, Christopher G. [1 ]
Orszulak, Thomas A. [1 ]
机构
[1] Mayo Clin, Div Cardiovasc Surg, Rochester, MN 55905 USA
[2] Mayo Clin, Div Biostat, Rochester, MN 55905 USA
关键词
D O I
10.1016/j.jtcvs.2007.10.065
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: Improved durability of bioprostheses has led some surgeons to recommend biologic rather than mechanical prostheses for patients younger than 65 years. We compared late results of contemporary bioprostheses and bileaflet mechanical prostheses in patients who underwent aortic valve replacement between 50 and 70 years old. Methods: In this retrospective study, patients received either St Jude bileaflet valves or Carpentier-Edwards bioprostheses. Operations were performed between January 1991 and December 2000, and groups were matched one-to-one according to age, sex, need for coronary artery bypass grafting, and valve size. Results: Four hundred forty patients were matched, and follow-up was 92% complete, with median durations of 9.1 years for patients who received mechanical valves and 6.2 years for patients who received bioprostheses. The 5-and 10-year unadjusted survivals were 87% and 68% for mechanical valves and 72% and 50% for bioprostheses, respectively (P =01). Freedoms from reoperation at 10 years were 98% for mechanical valves and 91% for bioprostheses (P =.06). Rates of late stroke or other embolic events and of endocarditis were similar between groups. Hemorrhagic complications necessitating hospitalization occurred in 15% of patients with mechanical valves and 7% of patients with bioprostheses (P =.01). Notably, 19% of patients with bioprostheses were receiving warfarin sodium at last follow-up. After adjustment for unmatched variables, including diabetes, renal failure, lung disease, New York Heart Association functional class, ejection fraction, and stroke, the use of a mechanical valve was protective against late mortality (hazard ratio 0.46, P =01). Conclusion: In this study, patients aged 50 to 70 years who underwent aortic valve replacement with mechanical valves had a survival advantage relative to matched patients who received bioprostheses. These findings question recommendations of bioprostheses for younger patients and suggest that a randomized trial may be warranted.
引用
收藏
页码:878 / 884
页数:7
相关论文
共 21 条
[1]   ACC/AHA 2006 guidelines for the management of patients with valvular heart disease [J].
Bonow, Robert O. ;
Carabello, Blase A. ;
Chatterjee, Kanu ;
de Leon, Antonio C., Jr. ;
Faxon, David P. ;
Freed, Michael D. ;
Gaasch, William H. ;
Lytle, Bruce Whitney ;
Nishimura, Rick A. ;
O'Gara, Patrick T. ;
O'Rourke, Robert A. ;
Otto, Catherine M. ;
Shah, Pravin M. ;
Shanewise, Jack S. ;
Smith, Sidney C., Jr. ;
Jacobs, Alice K. ;
Adams, Cynthia D. ;
Anderson, Jeffrey L. ;
Antman, Elliott M. ;
Faxon, David P. ;
Fuster, Valentin ;
Halperin, Jonathan L. ;
Hiratzka, Loren F. ;
Hunt, Sharon A. ;
Lytle, Bruce W. ;
Nishimura, Rick ;
Page, Richard L. ;
Riegel, Barbara .
CIRCULATION, 2006, 114 (05) :E84-E231
[2]   Performance of bioprostheses and mechanical prostheses assessed by composites of valve-related complications to 15 years after aortic valve replacement [J].
Chan, V. ;
Jamieson, W. R. E. ;
Germann, E. ;
Chan, F. ;
Miyagishima, R. T. ;
Burr, L. H. ;
Janusz, M. T. ;
Ling, H. ;
Fradet, G. J. .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2006, 131 (06) :1267-1273
[3]   IMPROVING THE AUTOPSY RATE AT A UNIVERSITY HOSPITAL [J].
CLAYTON, SA ;
SIVAK, SL .
AMERICAN JOURNAL OF MEDICINE, 1992, 92 (04) :423-426
[4]   Twenty-year follow-up of the Hancock modified orifice porcine aortic valve [J].
Cohn, LH ;
Collins, JJ ;
Rizzo, RJ ;
Adams, DH ;
Couper, GS ;
Aranki, SF .
ANNALS OF THORACIC SURGERY, 1998, 66 (06) :S30-S34
[5]   Reoperation of the aortic valve in octogenarians [J].
Eitz, Thomas ;
Fritzsche, Dirk ;
Kleikamp, Georg ;
Zittermann, Armin ;
Horstkotte, Dieter ;
Koerfer, Reiner .
ANNALS OF THORACIC SURGERY, 2006, 82 (04) :1385-1391
[6]   Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: Final report of the Veterans Affairs randomized trial [J].
Hammermeister, K ;
Sethi, GK ;
Henderson, WG ;
Grover, FL ;
Oprian, C ;
Rahimtoola, SH .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2000, 36 (04) :1152-1158
[7]   Which heart valve prosthesis for patients aged between 60 and 70 years? [J].
Hanania, G .
HEART, 2003, 89 (05) :481-482
[8]  
Hanania G, 2002, J AM COLL CARDIOL, V39, p423A
[9]   Medtronic intact porcine bioprosthesis experience to twelve years [J].
Jamieson, WRE ;
Lemieux, MD ;
Sullivan, JA ;
Munro, AI ;
Métras, J ;
Cartier, PC .
ANNALS OF THORACIC SURGERY, 2001, 71 (05) :S278-S281
[10]   Twenty-year comparison of tissue and mechanical valve replacement [J].
Khan, SS ;
Trento, A ;
DeRobertis, M ;
Kass, RM ;
Sandhu, M ;
Czar, LSC ;
Blanche, C ;
Raissi, S ;
Fontana, GR ;
Chang, W ;
Chaux, A ;
Matloff, JM .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2001, 122 (02) :257-269