Long-term outcome after biologic versus mechanical aortic valve replacement in 841 patients.

OBJECTIVE The purpose of this study was to optimize selection criteria of biologic versus mechanical valve prostheses for aortic valve replacement. METHODS Retrospective analysis was performed for 841 patients undergoing isolated, first-time aortic valve replacement with Carpentier-Edwards (n = 429) or St Jude Medical (n = 412) prostheses. RESULTS Patients with Carpentier-Edwards and St Jude Medical valves had similar characteristics. Ten-year survival was similar in each group (Carpentier-Edwards 54% 3% versus St Jude Medical 50% 6%; P =.4). Independent predictors of worse survival were older age, renal or lung disease, ejection fraction less than 40%, diabetes, and coronary disease. Carpentier-Edwards versus St Jude Medical prostheses did not affect survival (P =.4). Independent predictors of aortic valve reoperation were younger age and Carpentier-Edwards prosthesis. The linearized rates of thromboembolism were similar, but the linearized rate of hemorrhage was lower with Carpentier-Edwards prostheses (P <.01). Perivalvular leak within 6 months of operation was more likely with St Jude Medical than with Carpentier-Edwards prostheses (P =.02). Estimated 10-year survival free from valve-related morbidity was better for the St Jude Medical valve in patients aged less than 65 years and was better for the Carpentier-Edwards valve in patients aged more than 65 years. Patients with renal disease, lung disease (in patients more than age 60 years), ejection fraction less than 40%, or coronary disease had a life expectancy of less than 10 years. CONCLUSIONS For first-time, isolated aortic valve replacement, mechanical prostheses should be considered in patients under age 65 years with a life expectancy of at least 10 years. Bioprostheses should be considered in patients over age 65 years or with lung disease (in patients over age 60 years), renal disease, coronary disease, ejection fraction less than 40%, or a life expectancy less than 10 years.

[1]  G. Laub,et al.  Early and late-phase events after valve replacement with the St. Jude Medical prosthesis in 1200 patients. , 1994, The Journal of thoracic and cardiovascular surgery.

[2]  F. Loop,et al.  Primary isolated aortic valve replacement. Early and late results. , 1989, The Journal of thoracic and cardiovascular surgery.

[3]  D J Wheatley,et al.  Twelve-year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses. , 1991, The New England journal of medicine.

[4]  F. Sebening,et al.  Bioprosthetic and mechanical valves in the elderly: benefits and risks. , 1995, The Annals of thoracic surgery.

[5]  W. White,et al.  Comparison of anticoagulation regimens after Carpentier-Edwards aortic or mitral valve replacement. , 1994, Circulation.

[6]  F. Grover,et al.  Comparison of the causes of late death following aortic and mitral valve replacement. VA Co-operative Study on Valvular Heart Disease. , 1994, The Journal of heart valve disease.

[7]  G. Vlahakes,et al.  Risk of reoperative valve replacement for failed mitral and aortic bioprostheses. , 1998, The Annals of thoracic surgery.

[8]  G F Tyers,et al.  Clinical performance of biological and mechanical prostheses. , 1995, The Annals of thoracic surgery.

[9]  M. Edwards,et al.  Aortic valve replacement in patients 80 years of age and older: survival and cause of death based on 1100 cases: collective results from the UK Heart Valve Registry. , 1997, Circulation.

[10]  R. Leachman,et al.  Early and late mortality of patients undergoing aortic valve replacement after previous coronary artery bypass graft surgery. , 1995, Circulation.

[11]  W. Jamieson,et al.  Carpentier-Edwards standard and supra-annular porcine bioprostheses: 10 year comparison of structural valve deterioration. , 1994, The Journal of heart valve disease.

[12]  W. Jamieson,et al.  Porcine bioprostheses in the elderly: clinical performance by age groups and valve positions. , 1995, The Annals of thoracic surgery.

[13]  H. Reichenspurner,et al.  Comparison of porcine biological valves with pericardial valves--a 12-year clinical experience with 1123 bio-prostheses. , 1995, The Thoracic and cardiovascular surgeon.

[14]  R. Emery,et al.  Utilization of the St. Jude Medical prosthesis in the aortic position. , 1996, Seminars in thoracic and cardiovascular surgery.

[15]  M. Marchand,et al.  The last generation of pericardial valves in the aortic position: ten-year follow-up in 589 patients. , 1996, The Annals of thoracic surgery.

[16]  K. Miyatake,et al.  Choice of replacement valve in the elderly. , 1997, The Journal of heart valve disease.

[17]  W D White,et al.  Determinants of reoperation after 960 valve replacements with Carpentier-Edwards prostheses. , 1994, The Journal of thoracic and cardiovascular surgery.

[18]  L. Edmunds,et al.  Clinical comparison of St. Jude and porcine aortic valve prostheses. , 1985, Circulation.

[19]  K. Caidahl,et al.  Mechanical versus biological valve prosthesis: a ten-year comparison regarding function and quality of life. , 1995, The Annals of thoracic surgery.

[20]  A Starr,et al.  Actuarial versus actual risk of porcine structural valve deterioration. , 1994, The Journal of thoracic and cardiovascular surgery.

[21]  L. Cohn,et al.  Guidelines for reporting morbidity and mortality after cardiac valvular operations. , 1996, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[22]  A. Mazzucco,et al.  Aortic valve replacement with the Hancock standard, Björk-Shiley, and Lillehei-Kaster prostheses. A comparison based on follow-up from 1 to 15 years. , 1989, The Journal of thoracic and cardiovascular surgery.

[23]  W. E. Jamieson,et al.  Modern Cardiac Valve Devices— Bioprostheses and Mechanical Prostheses: State of the Art , 1993, Journal of cardiac surgery.

[24]  J E Okies,et al.  Long-term durability and patient functional status of the Carpentier-Edwards Perimount pericardial bioprosthesis in the aortic position. , 1998, The Journal of heart valve disease.

[25]  W. Baumgartner,et al.  Bioprosthetic versus mechanical prostheses for aortic valve replacement in the elderly. , 1996, Circulation.

[26]  W. Jamieson,et al.  Influence of coronary artery bypass and age on clinical performance after aortic and mitral valve replacement with biological and mechanical prostheses. , 1995, Circulation.

[27]  W G Henderson,et al.  A comparison of outcomes in men 11 years after heart-valve replacement with a mechanical valve or bioprosthesis. Veterans Affairs Cooperative Study on Valvular Heart Disease. , 1993, The New England journal of medicine.