{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:16:59Z","timestamp":1789705019958,"version":"4.0.1"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2013,4,23]]},"abstract":"<jats:sec>\n                    <jats:title>Background\u2014<\/jats:title>\n                    <jats:p>There is a paucity of long-term data comparing biological versus mechanical aortic valve prostheses in older individuals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results\u2014<\/jats:title>\n                    <jats:p>We performed follow-up of patients aged 65 to 80 years undergoing aortic valve replacement with a biological (n=24 410) or mechanical (n=14 789) prosthesis from 1991 to 1999 at 605 centers within the Society of Thoracic Surgeons Adult Cardiac Surgery Database using Medicare inpatient claims (mean, 12.6 years; maximum, 17 years; minimum, 8 years), and outcomes were compared by propensity methods. Among Medicare-linked patients undergoing aortic valve replacement (mean age, 73 years), both reoperation (4.0%) and endocarditis (1.9%) were uncommon to 12 years; however, the risk for other adverse outcomes was high, including death (66.5%), stroke (14.1%), and bleeding (17.9%). Compared with those receiving a mechanical valve, patients given a bioprosthesis had a similar adjusted risk for death (hazard ratio, 1.04; 95% confidence interval, 1.01\u20131.07), higher risks for reoperation (hazard ratio, 2.55; 95% confidence interval, 2.14\u20133.03) and endocarditis (hazard ratio, 1.60; 95% confidence interval, 1.31\u20131.94), and lower risks for stroke (hazard ratio, 0.87; 95% confidence interval, 0.82\u20130.93) and bleeding (hazard ratio, 0.66; 95% confidence interval, 0.62\u20130.70). Although these results were generally consistent among patient subgroups, bioprosthesis patients aged 65 to 69 years had a substantially elevated 12-year absolute risk of reoperation (10.5%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>Among patients undergoing aortic valve replacement, long-term mortality rates were similar for those who received bioprosthetic versus mechanical valves. Bioprostheses were associated with a higher long-term risk of reoperation and endocarditis but a lower risk of stroke and hemorrhage. These risks varied as a function of a patient\u2019s age and comorbidities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.113.002003","type":"journal-article","created":{"date-parts":[[2013,3,28]],"date-time":"2013-03-28T23:56:36Z","timestamp":1364514996000},"page":"1647-1655","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":215,"title":["Long-Term Safety and Effectiveness of Mechanical Versus Biologic Aortic Valve Prostheses in Older Patients"],"prefix":"10.1161","volume":"127","author":[{"given":"J. Matthew","family":"Brennan","sequence":"first","affiliation":[{"name":"From Duke Clinical Research Institute, Durham, NC (J.M.B., Y.Z., S.O., M.E.B., R.S.D., P.S.D., E.D.P.); and the Division of Cardiothoracic Surgery, University of Florida Health Science Center, Jacksonville, FL (F.H.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred H.","family":"Edwards","sequence":"additional","affiliation":[{"name":"From Duke Clinical Research Institute, Durham, NC (J.M.B., Y.Z., S.O., M.E.B., R.S.D., P.S.D., E.D.P.); and the Division of Cardiothoracic Surgery, University of Florida Health Science Center, Jacksonville, FL (F.H.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Zhao","sequence":"additional","affiliation":[{"name":"From Duke Clinical Research Institute, Durham, NC (J.M.B., Y.Z., S.O., M.E.B., R.S.D., P.S.D., E.D.P.); and the Division of Cardiothoracic Surgery, University of Florida Health Science Center, Jacksonville, FL (F.H.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"From Duke Clinical Research Institute, Durham, NC (J.M.B., Y.Z., S.O., M.E.B., R.S.D., P.S.D., E.D.P.); and the Division of Cardiothoracic Surgery, University of Florida Health Science Center, Jacksonville, FL (F.H.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Booth","sequence":"additional","affiliation":[{"name":"From Duke Clinical Research Institute, Durham, NC (J.M.B., Y.Z., S.O., M.E.B., R.S.D., P.S.D., E.D.P.); and the Division of Cardiothoracic Surgery, University of Florida Health Science Center, Jacksonville, FL (F.H.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel S.","family":"Dokholyan","sequence":"additional","affiliation":[{"name":"From Duke Clinical Research Institute, Durham, NC (J.M.B., Y.Z., S.O., M.E.B., R.S.D., P.S.D., E.D.P.); and the Division of Cardiothoracic Surgery, University of Florida Health Science Center, Jacksonville, FL (F.H.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela S.","family":"Douglas","sequence":"additional","affiliation":[{"name":"From Duke Clinical Research Institute, Durham, NC (J.M.B., Y.Z., S.O., M.E.B., R.S.D., P.S.D., E.D.P.); and the Division of Cardiothoracic Surgery, University of Florida Health Science Center, Jacksonville, FL (F.H.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric D.","family":"Peterson","sequence":"additional","affiliation":[{"name":"From Duke Clinical Research Institute, Durham, NC (J.M.B., Y.Z., S.O., M.E.B., R.S.D., P.S.D., E.D.P.); and the Division of Cardiothoracic Surgery, University of Florida Health Science Center, Jacksonville, FL (F.H.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","unstructured":"Health Research International Report. 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