Cardiac valve replacement with mechanical prostheses in patients aged 65 years and over.

摘要

BACKGROUND AND AIM OF THE STUDY: Recent data regarding the performance of mechanical prostheses in patients aged > or =65 years are scant. Hence, the outcome of mechanical prosthesis implantation in this age group has been retrospectively evaluated. METHODS: Between January 1990 and October 2002, 253 patients (163 males, 90 females) aged > or =65 years (mean age 68.2 years) underwent aortic valve replacement (AVR) and/or mitral valve replacement (MVR) at the authors' institution. RESULTS: Among the patients, 94 (37.2%) had MVR, 137 (54.1%) had AVR, and 22 (8.7%) had MVR+AVR. In total, 99 patients (39.1%) had concomitant coronary artery bypass grafting (CABG). The early mortality rate was 11.1%; that for patients aged > or =70 years was greater than that for patients aged 65-69 years (14.5% versus 9.6%, p <0.001). The overall actuarial survival was 91.3 +/- 2.4% at 5 years, 81.1 +/- 4.1% at 8 years, and 73.8 +/- 6.3% at 10 years. Actuarial survival for patients with isolated AVR and MVR at 10 years was 84.7 +/- 6.0% and 61.4 +/- 18.8%, respectively. Actuarial survival at 10 years for patients with isolated valve replacement was 76.1 +/- 8.1%, and 68.7 +/- 10.2% for patients with concomitant CABG (p = 0.680). Actuarial survival at 10 years was 81.3 +/- 6.9% for patients aged 65-69 years, and 50.3 +/- 11.0% for patients aged > or =70 years (p = 0.001). Freedom from a major thromboembolic event was 99.4 +/- 0.7% at five years and 86.3 +/- 6.0% at 10 years, while freedom from hemorrhage was 90.4 +/- 2.6% and 70.3 +/- 6.8%, respectively. CONCLUSION: Mechanical prostheses can be used in patients aged > or =65 years, with favorable results. However, on the basis of the present findings, patients aged > or =70 years have a reduced early and late survival.