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J Thorac Cardiovasc Surg 2006;131:1267-1273
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Performance of bioprostheses and mechanical prostheses assessed by composites of valve-related complications to 15 years after aortic valve replacement

Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.

Received for publication July 12, 2005; revisions received November 21, 2005; accepted for publication November 30, 2005.

^_* Address for reprints: W. R. Eric Jamieson, MD, 486 Burrard Building, St Paul's Hospital, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6. (Email: wrej{at}interchange.ubc.ca).

OBJECTIVE: This study was conducted to compare the composites of valve-related complications, namely reoperation, morbidity (defined as permanent neurologic or other functional impairment), and mortality, between bioprostheses and mechanical prostheses for aortic valve replacement.

METHODS: Between 1982 and 1998, 2195 bioprostheses were implanted in 2179 patients and 980 mechanical prostheses were implanted in 883 patients. Total follow-up was 16,442 years and 5740 years for bioprostheses and mechanical prostheses, respectively. Eight variables were considered as predictors of risk for the composites of valve-related complications.

RESULTS: Linearized rates for valve-related reoperation were 1.3%/patient-year and 0.3%/patient-year for bioprostheses and mechanical prostheses (P < .001), respectively. All age groups were differentiated, except >70 years. Valve-related morbidity was differentiated for all age groups and overall, for bioprostheses and mechanical protheses, was 0.4 %/patient-year and 2.1%/patient-year, respectively (P < .001). Overall valve-related mortality was 1.0%/patient-year for bioprostheses and 0.7%/patient-year for mechanical prostheses (P = .018). Age and valve-type were predictive risk factors for reoperation and morbidity, whereas age alone was predictive of mortality. Actual freedom from valve-related reoperation favored mechanical prostheses for all age groups, except 61-70 years and >70 years. Actual freedom from valve-related morbidity favored bioprostheses in all age groups, except 40 years. Actual freedom from valve-related mortality was undifferentiated in patients 51-60, 61-70, and >70 years.

CONCLUSION: No differences were observed in valve-related reoperation and mortality in patients >60 years. Comparative evaluation gives high priority for bioprostheses in patients >60 years based on improved morbidity profile. This evaluation extends this center's recommendation for bioprostheses in aortic valve replacement to include patients >60 years.

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