Key result
Mechanical AVR in patients under 65 is linked to ~62% lower mortality versus older patients.
Why the study?
Does patient age or prosthesis model affect long-term survival and valve-related morbidity in Japanese patients undergoing aortic valve replacement with St. Jude Medical mechanical prostheses?
Cohort (n=240)
No
Does patient age or prosthesis model affect long-term survival and valve-related morbidity in Japanese patients undergoing aortic valve replacement with St. Jude Medical mechanical prostheses?
Absolute Event Rate: 2.5% vs 6.6%
p-value: p=<0.0001
St. Jude Medical mechanical prostheses provide excellent long-term durability in Japanese patients, but elderly patients (≥65 years) experience significantly higher rates of mortality and bleeding events, suggesting a potential need for lower target PT-INR or bioprostheses in this demographic.
Equivalent durability across SJM models supports model flexibility in AVR; age-related gaps leave selection criteria open for elderly patients.
BACKGROUND: The long-term results achieved with aortic St. Jude Medical (SJM) mechanical prostheses in various age groups of Japanese patients have not been previously compared or reported. METHODS AND RESULTS: Since 1981, a total of 240 SJM valves were implanted in 79 patients using the Standard model, in 58 patients with the Hemodynamic Plus model, and in 103 patients with the Regent model for aortic valve replacement (AVR). Follow-up was completed for 2,397 patient-years in 97.5% of the patients, among whom the effect of age was compared, and the subjects were divided into younger (<65 years) and older (≥65 years) groups. Hospital mortality rate was 2.5%. No structural valve deterioration was observed during the follow-up period. In addition, no significant differences were observed in long-term survival between the 3 models. In contrast, significantly better rates of freedom from all-cause death (P<0.0001), valve-related death (P=0.0018) and valve-related morbidity (P=0.0021), including bleeding events (P=0.0007), were observed in the younger group (n=157, 50.6±1.0 years old) than in the older group (n=83, 72.5±0.7 years old). CONCLUSIONS: All types of SJM valve used for single AVR achieved satisfactory early and long-term results in each age group even 25 years after surgery. When selecting this prosthesis for elderly patients, however, relatively worse performance may be expected compared with that observed in younger patients.
No takes yet. Share an insight, caveat, or question.
Nishida et al. (2015) conducted a cohort in Aortic valve disease requiring replacement (n=240). Age <65 years at time of aortic valve replacement vs. Age ≥65 years was evaluated on All-cause death (linearized ratio %/patient-years) (p=<0.0001). Younger patients (<65 years) undergoing aortic valve replacement with St. Jude Medical mechanical prostheses had significantly lower rates of all-cause death and valve-related morbidity compared to older patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: