Original article
Adult cardiac
Carpentier-Edwards Pericardial Valve in the Aortic Position: 25-Years Experience

https://doi.org/10.1016/j.athoracsur.2013.03.032Get rights and content

Background

The Carpentier-Edwards pericardial valve was designed to minimize structural valve deterioration. Excellent durability and low incidence of valve-related complications have been reported. The objective of the present study was to analyze clinical results after 25 years of experience with this valve implanted in the aortic position. The effect of patient age at the time of surgery was also evaluated.

Methods

This is a retrospective cohort study of 2,405 patients from November 1981 to March 2011. Primary outcomes of interest were survival and freedom from major adverse effects such as thromboembolic, endocarditis, and reoperation.

Results

Sixty percent were male, with a mean age of 71 ± 9 years old. Actuarial survival rates including early deaths averaged 78% ± 2%, 55% ± 2%, and 16 % ± 2% after 5, 10, and 20 years of follow-up, respectively. The freedom rate of valve reoperation for prosthesis dysfunction and all other causes averaged 98 % ± 0.2%, 96% ± 1%, and 67% ± 4% at 5, 10, and 20 years. Patients younger than 60 years of age had a 15-year survival averaging 54% ± 5% compared with patients aged between 60 and 70 years of age averaging 46% ± 3% and with patients older than 70 years of age averaging 28% ± 3% (p = 0.001). Survival at 5, 10, and 20 years for patients who had concomitant CABG [coronary artery bypass grafting] were 78% ± 1%, 55% ± 2%, and 9% ± 3% compared with no concomitant CABG (84% ± 1%, 62% ± 2%, and 22% ± 3% (p < 0.001)).

Conclusions

Carpentier-Edwards pericardial valve implantation in the aortic position is secure and durable. The effects of age influence reoperation rate and survival as well as a concomitant coronary artery bypass procedure.

Section snippets

Patients and Methods

This retrospective cohort study reviewed 2,405 patients who underwent aortic valve replacement (AVR) with CE pericardial valves from November 1981 to March 2011. Patients with associated procedures such as aortoplasty and coronary artery bypass grafts (CABG) were included in this cohort. Patients who underwent repair or replacement of another valve concomitantly or a Bentall procedure were excluded from the present analysis (23%).

Data were prospectively recorded. Patients were followed at the

Survival and Functional Status

One hundred seventeen (117 of 2,405, 4.9%) patients died during the first 30 days after surgery. Cardiac failure and noncardiac problems were the main causes of early death. Postoperative complications included bleeding and tamponade and atrioventricular block as the 2 most frequent events (Table 2). Percentage of late death was 28% and total death including early deaths at 30 years was 33%. Causes of death were principally unknown (40%) followed by cardiac insufficiency (21%) and myocardial

Comment

The present study showed that the freedom rate from reoperation for structural valve deterioration (SVD) averaged 99% in patients older than 70 years of age at implantation throughout the 30-year period of the study. Rates of reoperation increased significantly in the younger groups of patients. Moreover, prosthetic valve endocarditis remains the first cause of valve reoperation in elderly patients and the second cause after SVD in younger patients.

Studies examining the experience with the CE

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