Aortic valve replacement with mechanical and biologic prosthesis in middle-aged patients.

Abstract

Mechanical prostheses are used in young patients and bioprostheses in the elderly because of the higher rate of structural failure of bioprostheses. The objective of the present study was to compare results after aortic valve replacement with mechanical (Carbo-Medics) and biologic (Carpentier-Edwards pericardial) in middle-aged patients. Five hundred twenty-one patients, aged between 55 and 65 years, who underwent aortic valve replacement with mechanical (n = 363) or biologic (n = 158) prostheses were reviewed. The 10-year actuarial survival rate averaged 66%+/-6% in patients implanted with mechanical valves compared with 75%+/-4% in patients implanted with biologic valves (p = 0.2). The 10-year freedom rate from thromboembolism, hemorrhage, and endocarditis averaged 92%+/-7%, 97%+/-2%, and 99%+/-1%, respectively, in patients with mechanical valves compared with 91%+/-3% (p = 0.03), 99%+/-1% (p = 0.4), and 95%+/-2% (p = 0.01), respectively, in those with biologic valves. The 10-year freedom rate from all valve-related complications averaged 90%+/-7% and 83%+/-4%, respectively (p = 0.01). The freedom rate from all valve-related complications was higher among patients with mechanical valves compared with biologic valves 10 years after aortic valve replacement in middle-aged patients.