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Mechanical Heart Valves in Septuagenarians
Author(s) -
Ascione R.,
Culliford L.,
Rogers C.A.,
Wild J.,
Narajan P.,
Angelini G.D.
Publication year - 2008
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.2007.00504.x
Subject(s) - medicine , cardiology , mechanical heart
Aim: To report on the use of a third‐generation bileaflet mechanical valve in septuagenarians, selected to receive a mechanical valve, as compared to (a) a younger cohort undergoing same valve implant (study 1) and to (b) a matched group of septuagenarians undergoing biological implant (study 2). Methods: The study was carried out in a tertiary regional hospital in South‐West England. Study 1: Consecutive series of 567 patients undergoing Sorin Bileaflet (SB) mechanical valve implant (437 patients < 70 years; 130 patients ≥ 70 years). Study 2 : 113 septuagenarians undergoing biological implant matched on age, valve type, concomitant coronary surgery, and operative priority to the SB septuagenarian group. Main outcome measures included in‐hospital mortality and morbidity and mid‐term valve‐related outcome. Results: Study 1: Septuagenarians were more likely to present with coronary disease, and to undergo coronary surgery (p < 0.01). In‐hospital mortality was 2.8% and 2.3% (p = 0.79) and neurological complications 1.4% versus 3.8% (p = 0.026) in the younger and older groups, respectively. Valve‐related mortality at two years was 1.8% (95%CI, 0.8% to 3.6%) and 4.8% (95% CI, 2.0% to 9.7%); cumulative three‐ year incidence of thromboembolic or major hemorrhagic event was 8.3% (95% CI, 5.7% to 12.0%) and 4.6% (95% CI, 1.7% to 12.4%) in the younger and older groups, respectively. Study 2: In‐hospital mortality was 1.8% and 7.1% in the SB and biological groups, respectively (ratio 0.25; 95% CI, 0.05 to 1.18, p = 0.058). The incidence of acute renal failure was greater in the biological group (risk ratio 0.30; 95% CI, 0.09 to 0.98, p = 0.035). There was no difference in mid‐term valve‐related mortality between groups (hazard ratio 0.53; 95% CI, 0.18 to 1.52, p = 0.24). Conclusion: The performance of SB valve in septuagenarians seems to be effective with no increased risk of in‐hospital mortality, bleeding, or thromboembolic events.