Long-Term Results of Aortic Valve Replacement With Mechanical Prosthesis or Carpentier-Edwards Perimount Bioprosthesis in Japanese Patients According to Age

Abstract

College of Cardiology guidelines revised in 2014 recommend BP for the patients aged >70 years, mechanical prosthesis (MP) for the patients aged <60 years, and either a BP or MP for the patients aged 60-70 years. 7 Due to the lack, however, of longterm results for the use of BP in AVR 8 and the small number of comparative studies 9 of different age groups in Japan, it remains debatable as to which type of prosthesis, BP or MP, is better for AVR in Japanese patients in their 60 s.The purpose of this study was to analyze our 30-year clinical experience with bileaflet MP and Carpentier-Edwards Perimount (CEP) BP for AVR in different age groups in order to clarify the optimal age for using BP for AVR. MethodsThis study involved human subjects and was reviewed and approved by the Institutional Review Board at Kyushu University. Between 4 November 1981 and 16 December 2013, 737 patients underwent AVR excluding aortic root replacement with bileaflet MP (n=424) or CEP BP (Edwards Lifesciences, Irvine, CA, he use of bioprostheses (BP) has been increasing worldwide along with improvements in durability. 1,2 The use of BP in Japan soared from 9.6% (707/7,364) in 1996 3 to 64.3% (9,832/15,284 valves) in 2011. 4 In our previous study, however, we found that the use of BP should be delayed until 70 years of age in the case of mitral valve replacement (MVR) in Japanese patients. 5 Editorial p 2627The European Society of Cardiology and the European Association for Cardio-Thoracic Surgery guidelines revised in 2012 indicate that the use of BP for aortic valve replacement (AVR) should be considered in patients aged >65 years (class IIa) and both valves are acceptable, and the choice requires careful analysis of factors other than age in patients aged 60-65. 6 The guidelines published by the Japanese Circulation Society in 2012 also recommend the use of BP in patients aged ≥65 years if the patient has no risk of thromboembolism (class I). Recently, the American Heart Association and American T Conclusions:The use of BP is suitable in patients aged ≥70 years, while the use of bileaflet MP is preferable in patients aged <60 years. Among patients aged 60-69 years, the use of BP is acceptable because of the lower incidence of anticoagulant-related events and the equivalent long-term survival. (Circ J 2014; 78: 2688 -2695

Long-Term Clinical Outcomes of the Carpentier-Edwards Perimount Pericardial Bioprosthesis in Chinese Patients with Single or Multiple Valve Replacement in Aortic, Mitral, or Tricuspid Positions

“…The results for 5-, 10-, and 15-year freedom from SVD according to age group are consistent with the findings of other studies on CE-P valves [4,15,16,20]. The study by Marchand et al [4] revealed that for patients who had undergone either isolated MVR or combined MVR and AVR, the freedom from SVD at 5, 10, and 14 years was 99.3 ± 0.7, 83.8 ± 3.3, and 59.2 ± 6.6%, respectively, for those ≤60 years of age, 100, 94.6 ± 2.2, and 76.0 ± 6.3% for those 61-70 years of age, and 100% at both 5 and 10 years for those >70 years of age.…”

“…The study by Marchand et al [4] revealed that for patients who had undergone either isolated MVR or combined MVR and AVR, the freedom from SVD at 5, 10, and 14 years was 99.3 ± 0.7, 83.8 ± 3.3, and 59.2 ± 6.6%, respectively, for those ≤60 years of age, 100, 94.6 ± 2.2, and 76.0 ± 6.3% for those 61-70 years of age, and 100% at both 5 and 10 years for those >70 years of age. In a study of 313 Japanese patients who had CE-P bioprostheses for AVR, the rate of freedom from SVD at 20 years was 54.2 ± 18% for those who were 60-69 years old and 29.5 ± 15% for those who were <60 years old [20]. These findings, similar to ours, suggested (1) that freedom from SVD differed between age groups, as seen in the patients ≥70 years, who infrequently developed SVD at 10 years or more following valve replacement, and (2) that SVD was more likely to occur in patients of the age group <60 years.…”

Comparison of the Long-Term Outcomes of Mechanical and Bioprosthetic Aortic Valves ― A Propensity Score Analysis ―

“…5 In particular, this study is unique because we compared these 2 types of valves using propensity score analysis by stratifying a large cohort according to the age cut-offs 60 and 70 years, as noted in the most recent ACC/AHA treatment guidelines. 1 We, as clinicians in daily practice, must insure that patients and their families are fully informed about the risks and benefits of both types of prosthetic valves, and we must allow them to decide based on this information.…”

Twenty-Year Outcome of Aortic Valve Replacement With St. Jude Medical Mechanical Valves in Japanese Patients

“…Although there have been numerous retrospective cohort studies comparing the outcomes of tissue vs. mechanical valves, 30 there have been only a few prospective randomized control clinical trials comparing tissue and mechanical prostheses. In the Veterans Administration Cooperative Study on Valvular Heart Disease, Hammermeister et al concluded that patients who underwent AVR with mechanical valves had better survival at 15 years than those who received tissue valves.…”