Document Detail


Aortic biological valve prosthesis in patients younger than 65 years of age: transition to a flexible age limit?
MedLine Citation:
PMID:  23287588     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Guidelines proposed bioprosthesis implantation for aortic valve disease if the patients were at least 65 years old at the time of surgery, with a trend towards even younger patients in recent years. Considering the adverse effects of lifetime anticoagulation, new biological valves (less prone to degeneration) and new technologies may lead patients and surgeons to different choices. Therefore, it is interesting to analyse the results of aortic bioprosthetic valve replacement in patients aged <65 years at the time of surgery.
METHODS: From January 2000 to December 2010, 84 patients aged <65 years at the time of surgery had undergone an aortic bio-prosthetic valve replacement. A mid-term follow-up [(FU) mean FU time: 54.4 ± 39.2 months] was done in August 2011 in all patients (FU completeness: 100%). Results were compared with patients who had a mechanical prosthetic aortic valve replacement during the same period.
RESULTS: The reoperation rate for structural valve degeneration (SVD) of bioprostheses was 6% and occurred exclusively among patients <56 years. Contraindications for anticoagulation determined the choice of a bioprosthesis among 83% of these patients. The personal preference to avoid anticoagulation was the leading cause in 68% of the older patients (56-65 years). Neurological complications occurred more frequently in the mechanical control group.
CONCLUSIONS: Reoperations for SVD after bioprosthesis implantation occurred exclusively among younger patients (<56 years), not suitable for systemic anticoagulation. Previous studies, together with our experience, are in favour of an age limit between 56 and 60 years, taking into consideration alternative transcatheter approaches to SVD treatment.
Authors:
Lars Niclauss; Ludwig Karl von Segesser; Enrico Ferrari
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2013-01-03
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  16     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-18     Completed Date:  2013-08-30     Revised Date:  2014-04-01    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  501-7     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Anticoagulants / therapeutic use
Aortic Valve / surgery*
Bioprosthesis*
Chi-Square Distribution
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation / adverse effects,  instrumentation*,  mortality
Hospital Mortality
Humans
Kaplan-Meier Estimate
Middle Aged
Patient Selection
Postoperative Complications / surgery
Prosthesis Design
Prosthesis Failure
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Anticoagulants
Comments/Corrections
Comment In:
Interact Cardiovasc Thorac Surg. 2013 Apr;16(4):507   [PMID:  23504754 ]
Interact Cardiovasc Thorac Surg. 2013 Apr;16(4):508   [PMID:  23504757 ]
Interact Cardiovasc Thorac Surg. 2013 Apr;16(4):507   [PMID:  23504755 ]
Interact Cardiovasc Thorac Surg. 2013 Apr;16(4):507-8   [PMID:  23504756 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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