Key result
Stentless biological valves perform similarly to mechanical valves mid-term but avoid higher major bleeding in patients >75.
Why the study?
The benefit of aortic valve replacement with stentless biological valves compared with mechanical valves in patients older than 65 years was assessed to address clinical outcome and quality of life differences.
Does aortic valve replacement with stentless biological valves improve outcomes and quality of life compared to mechanical valves in patients older than 65 years?
Cohort (n=392)
No
Does aortic valve replacement with stentless biological valves improve outcomes and quality of life compared to mechanical valves in patients older than 65 years?
In elderly patients undergoing aortic valve replacement, stentless biological valves offer emotional benefits by avoiding anticoagulation, but mechanical valves may be preferable in specific high-risk subgroups such as those with severe combined aortic disease or NYHA class IV.
Stentless valves may lower bleeding risk in patients >75 years without mid-term outcome differences; leaves open randomized confirmation for those >65 years.
OBJECTIVE: To assess the benefit for patients older than 65 years of aortic valve replacement with stentless biological heart valves in comparison with mechanical valves. DESIGN: Multiple regression analysis of a retrospective follow up study. SETTING: Single cardiothoracic centre. PATIENTS: Between 1996 and 2001, 392 patients with a mean age of 74 years underwent aortic valve replacement with stentless Freestyle bioprostheses or mechanical St Jude Medical prostheses. MAIN OUTCOME MEASURE: Operative mortality and morbidity, postoperative morbid events, mid term survival, and New York Heart Association (NYHA) class improvement, and quality of life. RESULTS: No significant differences were found between patients receiving stentless biological valves and patients receiving mechanical prostheses. However, analysis of subgroups showed that patients older than 75 years with mechanical valves had an increased risk of major bleeding events (p = 0.007). Patients requiring anticoagulation by means of coumarin had a twofold increased risk of an impaired emotional reaction (p = 0.052). However, for patients who received a mechanical valve for severe combined aortic valve disease a survival advantage (p = 0.045) and a decreased risk of prolonged ventilation (p = 0.001) was observed. On the other hand, patients receiving a stentless bioprosthesis had an increased risk of a prolonged stay in intensive care (p = 0.04) and stroke (p = 0.01) if they had severely reduced cardiac function (NYHA class IV). CONCLUSIONS: Elderly people receiving stentless bioprostheses benefit emotionally because of the avoidance of coumarin. However, in patients with severe hypertrophied ventricles and extraordinary calcifications, stentless bioprostheses should be chosen with caution.
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Ines Florath (2005) conducted a cohort in Aortic valve disease (n=392). Stentless biological heart valves vs. Mechanical heart valves was evaluated on Operative mortality and morbidity, postoperative morbid events, mid term survival, NYHA class improvement, and quality of life. Stentless biological valves showed no significant overall differences in mid-term outcomes compared to mechanical valves, though mechanical valves increased major bleeding risk in patients >75 years (p=0.007).
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