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(Circulation. 2005;111:2152-2153.)
© 2005 American Heart Association, Inc.

Editorial

Use of Heart Valves in Older Patients

Lawrence H. Cohn, MD

From the Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Mass.

Correspondence to Lawrence H. Cohn, MD, Division of Cardiac Surgery, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail lcohn@partners.org

Key Words: Editorials • aortic valve • bioprosthesis • fibrillation • aged

An extract of the first 250 words of the full text is provided, because this article has no abstract.

It has been known for at least 2 decades that the second- and third-generation porcine and pericardial bioprosthetic valves treated with glutaraldehyde are the preferable aortic valve devices in patients 65 years old who require aortic valve replacement.¹ Furthermore, many studies of patients in this age group, especially with coronary artery disease, have repeatedly demonstrated that these patients rarely outlive these valves.² Bioprosthetic cardiac valves do not need warfarin anticoagulation for patients in sinus rhythm, an advantage for older patients who have many concomitant disease states or existing conditions that contraindicate warfarin anticoagulation.³ Because of recent modifications in valve fabrication, including the use of glutaraldehyde at low fixation pressures, pericardial and porcine bioprosthetic valves have become even more reliable in terms of valve integrity and are clearly the choices for aortic valve replacement in older patients.⁴

See p 2178

That this principle has been appreciated for some time led to the codification of this concept in the American Heart Association/American College of Cardiology (AHA/ACC) valve guidelines published in 1998.⁵ Thus, the article in this issue of Circulation by Schelbert et al,⁶ who review >80 000 patients 65 years old who underwent isolated aortic valve replacement in >1000 US hospitals from 1999 to 2001, is a surprise. Many who work in valve surgery centers have taken the general principal of using tissue valves in older patients as part of today’s established practice guidelines. In our own experience from 1992 to 2004 at the Brigham and Women’s Hospital in 2447 patients 65 . . . [Full Text of this Article]

Related Article:

Hospital Volume and Selection of Valve Type in Older Patients Undergoing Aortic Valve Replacement Surgery in the United States

Erik B. Schelbert, Mary S. Vaughan-Sarrazin, Karl F. Welke, and Gary E. Rosenthal
Circulation 2005 111: 2178-2182. [Abstract] [Full Text]

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				E. B. Schelbert, G. E. Rosenthal, K. F. Welke, and M. S. Vaughan-Sarrazin Treatment Variation in Older Black and White Patients Undergoing Aortic Valve Replacement Circulation, October 11, 2005; 112(15): 2347 - 2353. [Abstract] [Full Text] [PDF]