Porcine bioprostheses in the elderly: Clinical performance by age groups and valve positions,

Porcine bioprostheses have been recommended and used for cardiac valve replacement in the elderly. A review of 1,984 patients with 2,042 operations, performed between 1975 and 1992, has afforded a detailed evaluation of clinical performance by valve positions and age groups within the elderly population. The numbers of operations performed by age groups were 65 to 69 years, 719; 70 to 74 years, 745; 75 to 79 years, 431; 80 to 84 years, 119; and 85 years or older, 28. The early mortality rate overall was 9.5% (195 patients), range 6.9% to 17.8% by age groups (p < 0.05), and 11.9% with concomitant procedures and 7.6% without (p < 0.05). The total cumulative follow-up was 10,060 patient-years (mean, 4.9 years). The late mortality rate was 7.0%/patient-year (for age groups, 5.8% to 13.4%/patient-year) (p = not significant). The patient survival at 15 years ranged from 25% ± 4% for 65 to 69 years to 9% ± 5% for 75 to 79 years (p < 0.05). The freedom from valve-related complications and composites at 10 years revealed differences (p < 0.05) by age groups only for structural valve deterioration: 85% ± 2% for 65 to 69 years versus 98% ± 2% for 80 to 84 years. The overall freedom from structural valve deterioration at 10 years for aortic valve replacement was 98% ± 1%; for mitral valve replacement, 79% ± 3%; and for multiple replacement, 86% ± 7% (p < 0.05, aortic valve replacement > mitral valve replacement). The freedom from structural valve deterioration by valve positions between age groups was different (p < 0.05). The freedom from structural valve deterioration for aortic valve replacement at 10 years was 95% ± 2% for 65 to 69 years and 99% ± 1% for 70 to 74 years. The freedom from structural valve deterioration for mitral valve replacement at 10 years was 70% ± 5% for 65 to 69 years, 90% ± 4% for 70 to 74 years, and 94% ± 6% for 75 to 79 years. The freedom from valve-related reoperation paralleled that for structural valve deterioration. The freedom from overall complications (morbidity and mortality) at 10 years was 70% ± 2% for aortic valve replacement, 54% ± 4% for mitral valve replacement, and 49% ± 9% for multiple replacement (p < 0.05). Porcine bioprostheses should still be implanted for aortic valve replacement in the elderly 65 years of age and older and for mitral valve replacement in patients 70 years of age and older. The incidence of valve-related complications remains low, and long-term survival is excellent.