Bioprosthetic valve replacement in the elderly

Abstract

One hundred and ten patients aged more than 65 years (mean, 73.4; range, 65-82) underwent successful bioprosthetic valve replacement (aortic, n = 71; mitral, n = 32; both, n = 7) from 1979 to 1985. The valve was pericardial in 39 cases and porcine in 78. The mean follow-up was 75 months (total, 688 patient-years; range, 2 months to 12 years). Actuarial patient survival was 79.4% at 5 years and 55.2% at 10 years. Thirty-seven patients died: 18 from valve-related causes and 19 from other causes. Eight patients have been reoperated on for valve-related complications (1.17% per patient-year): five primary deteriorations, two paravalvular leaks and one case of endocarditis. One surgical death occurred (12.5%). Twenty-five percent of the patients were receiving anticoagulants because of atrial fibrillation, and 5.4% developed severe bleeding (3.8% patient-year). Mid-term follow-up of these patients aged more than 65 years and undergoing bioprosthetic valve replacement surgery revealed a low rate of documented primary structural deterioration (0.9% per patient-year), a low mortality rate on reoperation (12.5%) and a high mortality rate due to non valve-related causes (51.4%).

Thromboembolic events after aortic valve replacement in elderly patients with a Carpentier-Edwards Perimount pericardial bioprosthesis

“…No increase in thromboembolism was found in patients with a Medtronic Hall valve and preoperative or postoperative atrial fibrillation, 2 yet the long-term risk for thromboembolism was considerably higher in patients with atrial fibrillation undergoing CABG 13 or aortic valve replacement with a Hancock porcine bioprosthesis. 14 In our and other 14,15 patient groups, atrial fibrillation was the main reason for therapy with warfarin sodium. The effect of warfarin sodium in a series of patients after aortic valve replacement with a Carpentier-Edwards pericardial bioprosthesis was studied earlier: an annual rate of thromboembolism of 0.8% with salicylic acid, of 1.5% with no treatment, and of 2.9% with warfarin sodium was observed in retrospect.…”