Porcine bioprostheses in the elderly : clinical performance by age groups and valve positions. Discussion

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 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.