{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T03:43:21Z","timestamp":1772163801123,"version":"3.50.1"},"reference-count":30,"publisher":"BMJ","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Heart"],"published-print":{"date-parts":[[2008,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To compare outcomes after aortic valve replacement (AVR) according to valve type specifically in older patients since valve-related risks are age-dependent; two randomised trials comparing mechanical and bioprosthetic valves found better outcomes with mechanical valves, but the samples were small and the patients were considerably younger than most who undergo AVR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>1199 US hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients:<\/jats:title>\n                    <jats:p>Patients 65 years and older undergoing AVR during 1991\u20132003 (n\u200a=\u200a307\u2009054) identified through Medicare claims data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures:<\/jats:title>\n                    <jats:p>Relative hazard ratios associated with bioprosthetic valves of (1) death (n\u200a=\u200a131\u2009719); (2) readmission for haemorrhage (n\u200a=\u200a31\u2009186), stroke (n\u200a=\u200a25\u2009051) or embolism (n\u200a=\u200a5870); (3) reoperation (n\u200a=\u200a4216); and (4) death or reoperation (reoperation free survival) in Cox regression analyses adjusting for demographic and clinical factors and hospital-level effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Overall, 36% of AVR patients received bioprosthetic valves. Bioprosthetic valve recipients were older (77 vs 75 years, p&lt;0.001) and generally had higher comorbidity. Bioprosthetic valve recipients had a slightly lower adjusted hazard ratios of death (HR\u200a=\u200a0.97; 95% CI 0.95 to 0.98); readmission for haemorrhage, stroke or embolism (HR\u200a=\u200a0.90, 95% CI 0.88 to 0.92); and death or reoperation (HR\u200a=\u200a0.97, 95% CI 0.96 to 0.98), but a higher hazard ratio of reoperation (HR\u200a=\u200a1.25, 95% CI 1.16 to 1.35). However, overall mortality and complication rates were more than 20 and 10 times higher, respectively, than the overall reoperation rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In older patients undergoing AVR, bioprosthetic valve recipients had slightly lower risks of death and complications, but a higher risk of reoperation. Given the low reoperation rate, these data suggest that bioprosthetic valves may be preferred in older patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/hrt.2007.127506","type":"journal-article","created":{"date-parts":[[2007,12,10]],"date-time":"2007-12-10T20:35:28Z","timestamp":1197318928000},"page":"1181-1188","source":"Crossref","is-referenced-by-count":32,"title":["Valve type and long-term outcomes after aortic valve replacement in older patients"],"prefix":"10.1136","volume":"94","author":[{"given":"E B","family":"Schelbert","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M S","family":"Vaughan-Sarrazin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K F","family":"Welke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G E","family":"Rosenthal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2007,12,10]]},"reference":[{"key":"2025092005054459000_94.9.1181.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.05.021"},{"key":"2025092005054459000_94.9.1181.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(98)00454-9"},{"key":"2025092005054459000_94.9.1181.3","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000163567.03454.EB"},{"key":"2025092005054459000_94.9.1181.4","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.104.530550"},{"key":"2025092005054459000_94.9.1181.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(00)00834-2"},{"key":"2025092005054459000_94.9.1181.6","doi-asserted-by":"publisher","DOI":"10.1136\/heart.89.7.715"},{"key":"2025092005054459000_94.9.1181.7","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.536102"},{"key":"2025092005054459000_94.9.1181.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2003.06.009"},{"key":"2025092005054459000_94.9.1181.9","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/S0735-1097(87)80263-2","article-title":"Comparison of outcome after valve replacement with a bioprosthesis versus a mechanical prosthesis: initial 5 year results of a randomized trial.","volume":"10","author":"Hammermeister","year":"1987","journal-title":"J Am Coll Cardiol"},{"key":"2025092005054459000_94.9.1181.10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199102283240901"},{"key":"2025092005054459000_94.9.1181.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2006.11.028"},{"key":"2025092005054459000_94.9.1181.12","doi-asserted-by":"publisher","DOI":"10.1378\/chest.119.1_suppl.22S"},{"key":"2025092005054459000_94.9.1181.13","doi-asserted-by":"publisher","DOI":"10.1378\/chest.119.1_suppl.108S"},{"key":"2025092005054459000_94.9.1181.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.05.013"},{"key":"2025092005054459000_94.9.1181.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.05.012"},{"key":"2025092005054459000_94.9.1181.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2003.07.008"},{"key":"2025092005054459000_94.9.1181.17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199310213291718"},{"key":"2025092005054459000_94.9.1181.18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMe058213"},{"key":"2025092005054459000_94.9.1181.19","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa035205"},{"key":"2025092005054459000_94.9.1181.20","unstructured":"2000 US census data. 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