Quality of life after implantation of bileaflet prostheses in elderly patients: an anticoagulation work group experience.

Abstract

The aim of the study was to examine our experience with the implant of bileaflet mechanical prostheses and with a centralized management of anticoagulation and the related risks in patients aged older than 70 years, focusing on the resulting expectancy and quality of life. Between January 1988 and January 2005, 681 consecutive patients older than 70 years (mean age, 73 +/- 3.3 years) underwent bileaflet prostheses implantation in an isolated procedure (77%) or concomitant with other procedures (23%). Data were retrospectively collected, and follow-up was conducted by mean of outpatient chart review and outpatient clinic controls. Follow-up included assessment of perceived quality of life through the Medical Outcomes Trust Short Form 36-Item Health Survey tool (SF-36). The scores obtained by the patients were compared with those of the Italian general population matched for age and sex. Hospital mortality was 11.8%, and 74 late deaths (12.3%) occurred. Mean follow-up was 4.38 +/- 2.85 years. Actuarial survival was 85.2% +/- 0.014% at 1 year, 77.9% +/- 0.017% at 5 years, 74.2% +/- 0.02% at 10 years, and 71.8% +/- 0.031% at 15 years. The mean international normalized ratio variability was 4.5% +/- 1.2%. Freedom from bleeding was 98.7% +/- 0.005% at 5 years and 98.3% +/- 0.007% at 10 and 15 years. Freedom from thromboembolism was 99.1% +/- 0.004% at 5 years, and 98.3% +/- 0.007% at 10 and 15 years. The mean SF-36 scores in the study patients were significantly higher than those of the general population matched for age and sex (p < 0.001 in all domains). Septuagenarian patients receiving mechanical valve prostheses did not experience increased rates of anticoagulation-related complications and perceived a satisfactory quality of life.