Quality of life after implantation of bileaflet prostheses in elderly patients: an anticoagulation work group experience.

BACKGROUND: The aim of the study was to examine our experience with the implant of bileaflet mechanical prostheses and with a centralized management of anticoagulation and the related risks in patients aged older than 70 years, focusing on the resulting expectancy and quality of life.

METHODS: Between January 1988 and January 2005, 681 consecutive patients older than 70 years (mean age, 73 +/- 3.3 years) underwent bileaflet prostheses implantation in an isolated procedure (77%) or concomitant with other procedures (23%). Data were retrospectively collected, and follow-up was conducted by mean of outpatient chart review and outpatient clinic controls. Follow-up included assessment of perceived quality of life through the Medical Outcomes Trust Short Form 36-Item Health Survey tool (SF-36). The scores obtained by the patients were compared with those of the Italian general population matched for age and sex.

RESULTS: Hospital mortality was 11.8%, and 74 late deaths (12.3%) occurred. Mean follow-up was 4.38 +/- 2.85 years. Actuarial survival was 85.2% +/- 0.014% at 1 year, 77.9% +/- 0.017% at 5 years, 74.2% +/- 0.02% at 10 years, and 71.8% +/- 0.031% at 15 years. The mean international normalized ratio variability was 4.5% +/- 1.2%. Freedom from bleeding was 98.7% +/- 0.005% at 5 years and 98.3% +/- 0.007% at 10 and 15 years. Freedom from thromboembolism was 99.1% +/- 0.004% at 5 years, and 98.3% +/- 0.007% at 10 and 15 years. The mean SF-36 scores in the study patients were significantly higher than those of the general population matched for age and sex (p < 0.001 in all domains).

CONCLUSIONS: Septuagenarian patients receiving mechanical valve prostheses did not experience increased rates of anticoagulation-related complications and perceived a satisfactory quality of life.