Replacement of the aortic valve in patients under 50 years of age: long-term follow-up of the St. Jude medical prosthesis

Emery, Robert W.; Erickson, Carla A; Arom, Kit V.; Northrup, William F.; Kersten, Thomas E.; Rueden, Thomas J. Von; Nicoloff, Demétre M.

doi:10.1016/s0003-4975(03)00016-x

Cited by 36 publications

(19 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…15,16 Only 1 patient in the mechanical valve group needed a reoperation because of a valve-related complication. These results correspond to the findings of Emery et al 31 who also described a low complication rate in the longterm follow-up of the St. Jude Medical prosthesis in young patients. One may speculate that anticoagulation-related complications mainly affect elderly patients.…”

Section: Advantages Of Stentless Xenograft Rootssupporting

confidence: 92%

“…Excessive bleeding complications or valve thromboses are mainly reported in the follow-up of patients with a Bjork-Shiley prosthesis, whereas modern bileaflet prostheses have been shown to have a lower incidence of these life-threatening complications. 30,31 A mechanically valved conduit remains the prosthesis of choice in young patients with aortic root disease and an aortic valve that is not amenable for repair. However, our data would suggest that the age threshold for the use of new-generation xenoroots may need to be lowered.…”

Section: Advantages Of Stentless Xenograft Rootsmentioning

confidence: 99%

See 1 more Smart Citation

Longevity After Aortic Root Replacement

et al. 2013

View full text Add to dashboard Cite

Background— The choice of the best conduit for root/ascending disease and its impact on longevity remain controversial in quinquagenarians. Methods and Results— A total of 205 patients (men=155) between 50 and 60 years (mean, 55.7±2.9 years) received either a stentless porcine xenoroot (n=78) or a mechanically valved composite prosthesis (n=127) between February 1998 and July 2011. Of these, 166 patients underwent root replacement for aneurysmal disease (porcine: 39% [n=65]; mechanical: 61% [n=101]; P =0.5), 25 for acute type A aortic dissection (porcine: 32% [n=8]; mechanical: 68% [n=17]; P =0.51), and 14 for endocarditis/iatrogenic injury involving the aortic root (6.4% [n=5] versus 7.1% [n=9]; P =1.0). The predominant aortic valve pathology was stenosis in 19% (n=38), regurgitation in 50% (n=102), combined valvular dysfunction in 26% (n=54), and normal aortic valve function in 5% (n=11). Concomitant procedures included coronary artery bypass grafting (13%), mitral valve repair (7%), and partial/complete arch replacement (12%/4%), with no significant differences between porcine and mechanical root replacement. Overall hospital mortality was 7.3%, with no difference between the 2 types of valve prostheses (7.7% for porcine and 7.1% for mechanical root replacement; P =1.0). Follow-up averaged 5.4±3.7 years (1096 patient-years) and was 100% complete. Freedom from aorta-related reoperation at 12 years was not statistically different between the groups (porcine: 94.9% versus mechanical: 96.1%; P =0.73). Survival was equivalent between both groups, with a 5-year survival of 86±3% (porcine: 88±4%; mechanical: 85±3%; P =0.96) and a 10-year survival of 76% (porcine: 80±7%; mechanical: 75±5%; P =0.84). The linearized mortality rate was 3.1%/patient-year (porcine: 2.9%/patient-year; mechanical: 3.2%/patient-year). Conclusions— In quinquagenerians, long-term survival after stentless porcine xenograft aortic root replacement is equivalent to that after a mechanical Bentall procedure. These results bring into question the predominance of mechanical composite conduits for root replacement in quinquagenerians, particularly in the current era of transcatheter valve-in-valve procedures for structural valve deterioration.

show abstract

Section: Advantages Of Stentless Xenograft Rootssupporting

confidence: 92%

Section: Advantages Of Stentless Xenograft Rootsmentioning

confidence: 99%

Longevity After Aortic Root Replacement

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Emery et al reported a rate of anticoagulant-related events of only 0.6%/patient-years and recommended the use of MP use in patients under 50 years of age. 22 Weber et al also noted a reduced mid-term survival among patients treated with BP, with similar valve-related event rates in both age group and concluded that current evidence remains insufficient to recommend BP for AVR in patients under 60 years of age. 23 Although these data also support the present conclusions, patients treated with MP have a potential risk of bleeding events due to anticoagulation as they age.…”

Section: Disclosuresmentioning

confidence: 94%

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

Nishida

Sonoda

Oishi

et al. 2014

Circ J

View full text Add to dashboard Cite

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

show abstract

“…Koertke notes however that a low dose anticoagulation regime should not be considered unless the patient is cooperative with self-testing, and long term follow up continues to be warranted [22]. A further report followed 254 patients after isolated AVR who were under the age of 50 years of age for up to 20 years and found valve related event rates were even less than that of Koertke [23]. This group had very few risk factors and few valve related events shown in percent per patient year in Table 5.…”

Section: Patient Risk Factorsmentioning

confidence: 99%

Anticoagulation for mechanical heart valves: a role for patient based therapy

Emery

Raikar

et al. 2007

J Thromb Thrombolysis

View full text Add to dashboard Cite

Anticoagulation management issues following mechanical cardiac valve replacement revolve around target levels for chronic oral anticoagulation. While these levels are important, they are only one aspect of a follow-up process that should be individualized to each patient with a mechanical cardiac valve and coupled with patient education, risk factor modification, and long-term follow-up. It is difficult to separate patient related risk factors, those traditional risk factors that markedly increase the incidence of potential valve related events (i.e., atrial fibrillation), and yet other more subtle non-traditional risk factors for thromboembolism (i.e., smoking and hypertension) that contribute to events. These also require management during the post-operative period and long-term follow-up. There are also different risk factors for anatomic valve position. The aortic valve is the safest of all the anatomic positions regarding valve related events. The mitral valve is at higher risk and the tricuspid valve is the most risky anatomic position. Anticoagulation related hemorrhage is the most dangerous event for mortality and morbidity in the aortic position, thromboembolism in the mitral position, and valve thrombosis in the tricuspid position. Each of these requires different degrees of patient modification and target levels for anticoagulation. Additionally, low risk patients with aortic valve replacement may not require anticoagulant therapy at all. Rather, treatment with modern, highly potent platelet inhibiting drugs may be effective after a period of sewing ring endothelialization under the protection of antithrombotic therapy. Each of these aspects and risk factors is discussed, as well as the call for prospective randomized trials treating low risk patients with anti-platelet drugs versus warfarin anticoagulation.

show abstract

Replacement of the aortic valve in patients under 50 years of age: long-term follow-up of the St. Jude medical prosthesis

Cited by 36 publications

References 5 publications

Longevity After Aortic Root Replacement

Longevity After Aortic Root Replacement

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

Anticoagulation for mechanical heart valves: a role for patient based therapy

Contact Info

Product

Resources

About