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J Thorac Cardiovasc Surg 1999;117:890-897
© 1999 Mosby, Inc.
SURGERY FOR ADULT CARDIOVASCULAR DISEASE |
From the Departments of Surgery and Medicine, Duke University Medical Center, Durham NC.
This study was funded in part by grants from St Jude Medical, Inc, and Baxter Healthcare Corp.
Received for publication Aug 26, 1998. Revisions requested Oct 5, 1998. Revisions received Jan 5, 1999. Accepted for publication Jan 5, 1999. Address for reprints: Donald D. Glower, MD; Box 3851, DUMC, Durham, NC 27710.
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.
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