Long-term results of the Carpentier-Edwards pericardial aortic valve: a 12-year follow-up.

BACKGROUND Pericardial valves have excellent hemodynamic function; however, long-term durability is questionable. To determine the function of the Carpentier-Edwards pericardial valve in the aortic position, the results of 310 aortic valve replacements performed between 1982 and 1985 were analyzed. Mean age was 64.2+/-10.8 years (range, 22 to 95 years); 190 (61.3%) were men. Isolated valve replacement was performed in 135 patients (43.5%). There were 18 hospital deaths (5.8%), none of them valve related. METHODS Follow-up of 292 survivors was 100% complete at a mean of 8.8 years; 2,556 patient-years of follow-up were analyzed. There were 150 late deaths (51.4%). Survival at 5, 10, and 12 years were 83%+/-2%, 47%+/-3%, and 34%+/-3%, respectively. The 12-year actuarial and actual freedom from thromboembolism was 87%+/-2% and 89%+/-2%, respectively. Freedom from hemorrhage was 91%+/-2% and 92%+/-2%; freedom from endocarditis was 93%+/-2% and 95% +/- 1%; and freedom from structural deterioration was 82%+/-4% and 91%+/-2%, respectively. RESULTS Actuarial freedom from structural deterioration at 12 years was considerably higher for 153 hospital survivors 65 years or older, 93% (5 explants) compared to 76% (19 explants) for patients younger than 65 years, p = 0.03. Of 24 explanted valves for structural deterioration, leaflet calcification resulting in stenosis occurred in 20 (83%) and 4 were wear-related leaflet tears. CONCLUSIONS We conclude that the Carpentier-Edwards pericardial valve has a low incidence of valve-related complications, that structural deterioration is infrequent and results from leaflet calcification, and that the low incidence of structural deterioration in patients 65 years or older makes this an increasingly appropriate option in this age group.

[1]  D. Cosgrove,et al.  The Carpentier-Edwards pericardial aortic valve: intermediate results. , 1992, The Annals of thoracic surgery.

[2]  G F Tyers,et al.  The Carpentier-Edwards standard porcine bioprosthesis. A first-generation tissue valve with excellent long-term clinical performance. , 1990, The Journal of thoracic and cardiovascular surgery.

[3]  E. Jones,et al.  Ten-year experience with the porcine bioprosthetic valve: interrelationship of valve survival and patient survival in 1,050 valve replacements. , 1990, The Annals of thoracic surgery.

[4]  M. Ionescu,et al.  Heart valve replacement with the Ionescu-Shiley pericardial xenograft. , 1977, The Journal of thoracic and cardiovascular surgery.

[5]  P E Oyer,et al.  Durability of porcine valves at fifteen years in a representative North American patient population. , 1992, The Journal of thoracic and cardiovascular surgery.

[6]  A Starr,et al.  Actuarial versus actual risk of porcine structural valve deterioration. , 1994, The Journal of thoracic and cardiovascular surgery.

[7]  E. Yellin,et al.  Hemodynamic performance of the Ionescu-Shiley valve prosthesis. , 1980, The Journal of thoracic and cardiovascular surgery.

[8]  J. Strom,et al.  Fatigue-induced failure of the Ionescu-Shiley pericardial xenograft in the mitral position. In vivo and in vitro correlation and a proposed classification. , 1984, The Journal of thoracic and cardiovascular surgery.

[9]  V. Walley,et al.  Patterns of failure in Ionescu-Shiley bovine pericardial bioprosthetic valves. , 1987, The Journal of thoracic and cardiovascular surgery.

[10]  G. Daughters,et al.  Five-year experience with the Ionescu-Shiley bovine pericardial valve in the aortic position. , 1983, The Annals of thoracic surgery.

[11]  W. Daggett,et al.  Late results with Carpentier-Edwards porcine bioprosthesis. , 1990, Circulation.

[12]  E. Jones,et al.  Interaction of age and coronary disease after valve replacement: implications for valve selection. , 1994, The Annals of thoracic surgery.

[13]  G F Tyers,et al.  Carpentier-Edwards standard porcine bioprosthesis: primary tissue failure (structural valve deterioration) by age groups. , 1988, The Annals of thoracic surgery.

[14]  P. Stein,et al.  The porcine bioprosthetic heart valve: experience at 15 years. , 1989, The Annals of thoracic surgery.

[15]  G L Hallman,et al.  Valve failure with the Ionescu-Shiley bovine pericardial bioprosthesis: analysis of 2680 patients. , 1985, Journal of vascular surgery.

[16]  R W Stewart,et al.  The Carpentier-Edwards pericardial aortic valve. Ten-year results. , 1995, The Journal of thoracic and cardiovascular surgery.