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Valve type and long-term outcomes after aortic valve replacement in older patients
  1. Erik B Schelbert (schelberteb{at}
  1. National Institutes of Health, United States
    1. Mary S Vaughan-Sarrazin (mary-vaughan-sarrazin{at}
    1. University of Iowa Carver College of Medicine & Iowa City VA Medical Center, United States
      1. Karl F Welke (welkek{at}
      1. Oregon Health and Science University, United States
        1. Gary E Rosenthal (gary-rosenthal{at}
        1. University of Iowa Carver College of Medicine & Iowa City VA Medical Center, United States


          Objective To compare outcomes after aortic valve replacement (AVR) according to valve type specifically in older patients since valve-related risks are age-dependent; two randomised trials comparing mechanical and bioprosthetic valves found better outcomes with mechanical valves, but the samples were small and considerably younger than most who undergo AVR.

          Design Cohort study

          Setting 1,199 US hospitals

          Patients Patients 65 years and older undergoing AVR during 1991-2003 (n=307,054) identified through Medicare claims data Main outcome measures: Relative hazards associated with bioprosthetic valves of: 1) death (n=131,719); 2) readmission for haemorrhage (n=31,186), stroke (n=25,051), or embolism (n=5,870); 3) reoperation (n=4,216); and 4) death or reoperation (reoperation free survival) in Cox regression analyses adjusting for demographic and clinical factors and hospital-level effects.

          Results Overall, 36% of AVR patients received bioprosthetic valves. Bioprosthetic valve recipients were older (77 vs. 75 yrs, p<0.001), and generally had higher comorbidity. Bioprosthetic valve recipients had a slightly lower adjusted hazards of death [HR=0.97; 95% CI 0.95-0.98]; readmission for haemorrhage, stroke, or embolism [HR=0.90, 95% CI 0.88-0.92]; and death or reoperation [HR=0.97, 95% CI 0.96-0.98], but a higher hazard of reoperation [HR=1.25, 95% CI 1.16-1.35]. However, overall mortality and complication rates were more than 20 and 10 times higher, respectively, than the overall reoperation rate.

          Conclusions In older patients undergoing AVR, bioprosthetic valve recipients had slightly lower risks of death and complications, but a higher risk of reoperation. Given the low reoperation rate, these data suggest that bioprosthetic valves may be preferred in older patients.

          • Epidemiology
          • Surgery
          • Survival
          • Valves

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