Clin Res Cardiol 96: Suppl 1 (2007)

V57 - Stentless biological versus mechanical aortic valves after 7 years of replacement
J. Ennker1, A. Albert1, U. Rosendahl1, I. C. Ennker1, I. Florath1
1Herzzentrum Lahr, Lahr/Baden;
Purpose: Since the two large randomised trials of the 1970s, comparing biological and mechanical valves, new designs of valve prostheses were developed. Later studies comparing modern prostheses were neither randomized nor adjusted for patient-related factors. To adjust for selection bias we used a propensity score.
Methods: Between 1996 and 2003, 870 patients older than 60 years underwent AVR with stentless Freestyle bioprostheses (N=517) and mechanical SJM prostheses (N=353). 201 matched-pairs were created based on a saturated propensity score. Total follow-up for all matched pairs was 1304 patient-years. Quality of life was assessed by the Nottingham Health Profile questionnaire.
Results: Survival after 7 years was 59±7% for the Freestyle- and 64±7% for the SJM-group (p=0.23). Freedom from reoperation, prosthetic valve endocarditis, major bleeding events and stroke was not significantly different between the two groups, p=0.16, p=0.32, p=0.66, p=0.13, respectively. No significant differences in QoL were found between the two groups. Patients requiring anticoagulation therapy (also 16% in the Freestyle group) were more often in pain (41% vs 29%, p=0.05). When patients requiring anticoagulation therapy where younger than 70 years, they suffered more from loss of energy (46% vs 28%, p=0.05) and limited physical mobility (40% vs 21%, p=0.04). Patients requiring anticoagulation therapy older than 70 years felt less socially isolated (12% vs 26%, p=0.05) probably due to regular medical visits.
Conclusion: Riskadjusted comparison of complications after stentless biological and mechanical aortic valve replacement in patients older 60 years did not reveal any significantly difference within 7 years. Concerning their quality of life patients younger than 70 years seem to benefit from avoidance of anticoagulation therapy.