Anaheim, Calif—A long-term follow-up study presented at the annual meeting here of the American College of Cardiology has given surgeons a clear answer to the question of whether to perform heart valve replacement with a mechanical or a bioprosthetic device.
The answer is: It depends.
Shahbudin H. Rahimtoola, MD, of the University of Southern California School of Medicine, presented the final report of the Veterans Administration Randomized Trial. He said the results demonstrate that for the first 10 years of use there is no difference in mortality rates between valve types but that after 10 years the mortality rate climbs higher for those with a bioprosthetic valve compared with those with a mechanical—but that difference is seen only in patients who had the valve replacement surgery when they were under age 65. Therefore, Rahimtoola recommended using a mechanical valve for those under age 65 and a bioprosthetic for those 65 and older, because while the mortality rates were similar in the 65 and older population, those receiving bioprosthetic valves do not need to take the anticoagulants (and risk their associated complications) that are required with mechanical valves.
Mitka M. Final Report on Mechanical vs Bioprosthetic Heart Valves. JAMA. 2000;283(15):1947-1948. doi:10.1001/jama.283.15.1947-JMN0419-2-1