Biological versus mechanical prosthesis in 3279 patients from the Swedish in-patients register.

Abstract

OBJECTIVES:

To compare valve-related morbidity among patients aged < 70 and ≥ 70 years, receiving either a mechanical or a biological prosthesis in a population-based setting.

DESIGN:

In total, 3279 patients (21 644 patient-years) were followed up through the Swedish National In-Patients Register, which registers all hospital admissions. Death, thromboembolism, bleeding, endocarditis, valve thrombosis and reoperations were all captured.

RESULTS:

Survival was lower among patients aged <70 years with a bioprosthesis compared to a mechanical prosthesis (p < 0.0001), but equal among older patients. A mechanical prosthesis indicated a lower risk (p < 0.001) of thromboembolism (1.5% per patient year, ppy), than bioprosthesis (2.6% ppy), irrespective of age. Bleeding was increased (p = 0.002) with a mechanical prosthesis (1.7% ppy) compared to a bioprosthesis (1.1% ppy); the risk of bleeding increased early (<5 years) whereas thromboembolism increased late (>5 years). Event-free survival was higher in younger patients with a mechanical prosthesis compared to bioprosthesis recipients (p < 0.001), but equal among older patients.

CONCLUSIONS:

Survival was comparable in older patients irrespective of prosthesis type. Bleeding was increased with a mechanical prosthesis, especially in the elderly. The risk of thromboembolism was higher in patients with a bioprosthesis.

• Authors: Laila Hellgren, Fredrik Granath, Anders Ekbom, Elisabeth Ståhle
• Journal: Scandinavian cardiovascular journal : SCJ (Scand Cardiovasc J) Vol. 45 Issue 4 Pg. 223-8 (Aug 2011) ISSN: 1651-2006 [Electronic] England
• PMID: 21506653 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Age Factors
• Aged
• Bioprosthesis (adverse effects)
• Female
• Follow-Up Studies
• Heart Valve Prosthesis (adverse effects)
• Hemorrhage (etiology, mortality)
• Humans
• Male
• Postoperative Complications (etiology, mortality)
• Registries
• Survival Rate
• Sweden
• Thromboembolism (etiology, mortality)