OBJECTIVES: To compare valve-related morbidity among patients aged < 70 and ≥ 70 years, receiving either a mechanical or a biological prosthesis in a population-based setting. DESIGN: In total, 3279 patients (21 644 patient-years) were followed up through the Swedish National In-Patients Register, which registers all hospital admissions. Death, thromboembolism, bleeding, endocarditis, valve thrombosis and reoperations were all captured. RESULTS: Survival was lower among patients aged <70 years with a bioprosthesis compared to a mechanical prosthesis (p < 0.0001), but equal among older patients. A mechanical prosthesis indicated a lower risk (p < 0.001) of thromboembolism (1.5% per patient year, ppy), than bioprosthesis (2.6% ppy), irrespective of age. Bleeding was increased (p = 0.002) with a mechanical prosthesis (1.7% ppy) compared to a bioprosthesis (1.1% ppy); the risk of bleeding increased early (<5 years) whereas thromboembolism increased late (>5 years). Event-free survival was higher in younger patients with a mechanical prosthesis compared to bioprosthesis recipients (p < 0.001), but equal among older patients. CONCLUSIONS: Survival was comparable in older patients irrespective of prosthesis type. Bleeding was increased with a mechanical prosthesis, especially in the elderly. The risk of thromboembolism was higher in patients with a bioprosthesis.
OBJECTIVES: To compare valve-related morbidity among patients aged < 70 and ≥ 70 years, receiving either a mechanical or a biological prosthesis in a population-based setting. DESIGN: In total, 3279 patients (21 644 patient-years) were followed up through the Swedish National In-Patients Register, which registers all hospital admissions. Death, thromboembolism, bleeding, endocarditis, valve thrombosis and reoperations were all captured. RESULTS: Survival was lower among patients aged <70 years with a bioprosthesis compared to a mechanical prosthesis (p < 0.0001), but equal among older patients. A mechanical prosthesis indicated a lower risk (p < 0.001) of thromboembolism (1.5% per patient year, ppy), than bioprosthesis (2.6% ppy), irrespective of age. Bleeding was increased (p = 0.002) with a mechanical prosthesis (1.7% ppy) compared to a bioprosthesis (1.1% ppy); the risk of bleeding increased early (<5 years) whereas thromboembolism increased late (>5 years). Event-free survival was higher in younger patients with a mechanical prosthesis compared to bioprosthesis recipients (p < 0.001), but equal among older patients. CONCLUSIONS: Survival was comparable in older patients irrespective of prosthesis type. Bleeding was increased with a mechanical prosthesis, especially in the elderly. The risk of thromboembolism was higher in patients with a bioprosthesis.
Authors: Campbell D Flynn; Neil P Curran; Stephanie Chan; Isabel Zegri-Reiriz; Manel Tauron; David H Tian; Gosta B Pettersson; Joseph S Coselli; Martin Misfeld; Manuel J Antunes; Carlos A Mestres; Eduard Quintana Journal: Ann Cardiothorac Surg Date: 2019-11