OBJECTIVES: To compare mid- to long-term patient outcomes after heart valve replacement with mechanical to biological heart valves among elderly Medicare patients.

METHODS: This is a retrospective analysis of patients 65 years or older who underwent aortic valve replacement (AVR) in the 2006-2015 Medicare databases. Propensity analyses were used to control for bias in the treatment assignment and prognostic imbalance. Cox regression models were used to compare the long-term outcomes between mechanical and biological valves.

RESULTS: Of the 125,507 Medicare beneficiaries who met inclusion criteria, 34,619 (27.6%) received a mechanical valve and 90,888 (72.4%) received a biological valve. Mechanic valve recipients had a slightly higher adjusted hazard ratio (HR) of death than recipients of biological valves (HR: 1.07; 95% CI 1.04, 1.09). Subgroup analyses showed the mortality was 16% higher for recipients of mechanical compared with biological valves within 30 days after the surgery (HR: 1.16; 95% CI 1.10, 1.22); and the mortality was 5% higher after 30 days (HR: 1.05; 95% CI 1.02, 1.07). The risk for reoperation was 43% higher for recipients of mechanical compared with biological valves (HR: 1.43; 95% CI 1.14, 1.80). Consistent findings were observed in the subgroup analyses by gender and age groups.

CONCLUSIONS: In this cohort analyses of Medicare beneficiaries, mechanical valve recipients had higher risks of both death and reoperation. These data suggest that biological valves may be preferred in older patients.