Aortic valve replacement using a bioprosthetic versus mechanical valve in elderly patients resulted in similar 30-day mortality (1.9% vs. 5.8%, p=0.618) and 8-year overall survival.
Cohort (n=277)
Does aortic valve replacement with a mechanical valve compared to a bioprosthetic valve improve survival or reduce complications in elderly patients aged ≥75 years?
In propensity-matched elderly patients (≥75 years) undergoing aortic valve replacement, mechanical valves demonstrated comparable 8-year survival and complication rates to bioprosthetic valves.
Absolute Event Rate: 1.9% vs 5.8%
p-value: p=0.618
BACKGROUND AND AIM OF THE STUDY: There is still controversy on the use of mechanical valves to treat elderly patients with a small aortic annulus who require aortic valve replacement (AVR). We compared our results in elderly patients who underwent AVR with a bioprosthetic or mechanical valve. Propensity matching adjusted for baseline differences in this study. METHODS: Between January 2001 and July 2014, 277 patients aged ≥75 years old who underwent AVR were enrolled. Of 277 patients, 104 patients were selected using propensity score matching analysis. Out of this cohort, 52 patients underwent AVR with a bioprosthetic valve (B group) and the remainder AVR with a mechanical valve (M group). RESULTS: There were no significant differences between the B and M groups in 30 days mortality (1.9% vs. 5.8%, p = 0.618). The incidence of patient-prosthesis mismatch (PPM) after AVR tended to be lower in the M group than in the B group. The overall survival rates in the B and M groups at eight years were 72.8% and 73.3%, respectively (p = 0.473). No significant differences between the two groups were observed in freedom from valve-related death, cardiac events, bleeding events, or stroke events. CONCLUSIONS: AVR in elderly patients achieved relatively good short-term and long-term outcomes, and the incidence rates of valve-related complications after using a mechanical valve were low. In a selected population of elderly patients, a mechanical valve may be acceptable. doi: 10.1111/jocs.12719 (J Card Surg 2016;31:195-202).
Okamoto et al. (Wed,) conducted a cohort in Aortic valve disease requiring replacement (n=277). Bioprosthetic valve vs. Mechanical valve was evaluated on 30-day mortality (p=0.618). Aortic valve replacement using a bioprosthetic versus mechanical valve in elderly patients resulted in similar 30-day mortality (1.9% vs. 5.8%, p=0.618) and 8-year overall survival.
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