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• W2110698941 abstract "<h3>Objective:</h3> To compare outcomes after aortic valve replacement (AVR) according to valve type specifically in older patients since valve-related risks are age-dependent; two randomised trials comparing mechanical and bioprosthetic valves found better outcomes with mechanical valves, but the samples were small and the patients were considerably younger than most who undergo AVR. <h3>Design:</h3> Cohort study. <h3>Setting:</h3> 1199 US hospitals. <h3>Patients:</h3> Patients 65 years and older undergoing AVR during 1991–2003 (n = 307 054) identified through Medicare claims data. <h3>Main outcome measures:</h3> Relative hazard ratios associated with bioprosthetic valves of (1) death (n = 131 719); (2) readmission for haemorrhage (n = 31 186), stroke (n = 25 051) or embolism (n = 5870); (3) reoperation (n = 4216); and (4) death or reoperation (reoperation free survival) in Cox regression analyses adjusting for demographic and clinical factors and hospital-level effects. <h3>Results:</h3> Overall, 36% of AVR patients received bioprosthetic valves. Bioprosthetic valve recipients were older (77 vs 75 years, p<0.001) and generally had higher comorbidity. Bioprosthetic valve recipients had a slightly lower adjusted hazard ratios of death (HR = 0.97; 95% CI 0.95 to 0.98); readmission for haemorrhage, stroke or embolism (HR = 0.90, 95% CI 0.88 to 0.92); and death or reoperation (HR = 0.97, 95% CI 0.96 to 0.98), but a higher hazard ratio of reoperation (HR = 1.25, 95% CI 1.16 to 1.35). However, overall mortality and complication rates were more than 20 and 10 times higher, respectively, than the overall reoperation rate. <h3>Conclusions:</h3> In older patients undergoing AVR, bioprosthetic valve recipients had slightly lower risks of death and complications, but a higher risk of reoperation. Given the low reoperation rate, these data suggest that bioprosthetic valves may be preferred in older patients." @default.
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• W2110698941 date "2008-09-01" @default.
• W2110698941 modified "2023-09-30" @default.
• W2110698941 title "Valve type and long-term outcomes after aortic valve replacement in older patients" @default.
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• W2110698941 doi "https://doi.org/10.1136/hrt.2007.127506" @default.
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