THE INFLUENCE OF AGE ON THE DURABILITY OF CARPENTIER-EDWARDS BIOLOGICAL VALVES - 13 YEARS FOLLOW-UP

Two hundred and ninety-nine patients received 325 Carpentier-Edwards biological valves from April 1976 to April 1982. Valves were placed in the following positions: 150 aortic (AVR), 120 mitral (MVR), 26 multiple (MR), 2 pulmonary (PR) and 1 tricuspid (TR). The mean age was 54.7 years. The total follow-up time was 2545 patient-years. Patients were divided into different age groups: < 40, 40-49, 50-59, 60-69 and > 70 years and were followed-up for reoperations and tissue failure. Ninety-three operations were performed in 91 patients (30.5%) for valve related dysfunctions. The main cause of reoperation was primary tissue failure (85%). The respective incidence and risk of reoperation in the different age groups were 51.5% and 5%, 41.5% and 4%, 32% and 3%, 18% and 2.5%, and 0% for > 70 years of age. The risk of reoperation decreased significantly with increasing age (P < 0.05). The respective incidence and risk of tissue failure in the age groups were 43.8% and 4.1%, 35% and 4%, 27.3% and 3.2%, and 17.2%, 2.4% and 0%. The freedom from reoperation and tissue failure was significantly higher in the older patient (> 60 years) compared to the younger patients (< 60 years). The commonest cause of failure in young patients was calcification, while in older patients it was cusp rupture. Comparing aortic and mitral bioprostheses in the different age groups showed no difference between these valves in patients < 50 years of age. In patients > 50 years of age, there was a significantly higher incidence of reoperation (P < 0.05) and risk (P < 0.05) in patients with mitral bioprostheses compared to those with bioprostheses.