Determinants of 15-year outcome with 1,119 standard Carpentier-Edwards porcine valves

Background. The determinants of long-term outcome 15 years or more after porcine valve replacement are poorly documented. Methods. A retrospective review was performed of patients undergoing valve replacement with standard Carpentier-Edwards aortic (n = 531), mitral (n = 492), and tricuspid (n = 96) valves. Results. Patient survival was 26% +/- 3%, 23% +/- 2%, and 31% +/- 8% 15 years after aortic, mitral, and tricuspid valve replacements, respectively. Independent determinants of impaired long-term survival for aortic or mitral valve replacement were multiple valve replacement, older age, renal disease, lung disease, or coronary disease. Actual (versus actuarial) freedom from reoperation at 15 years was 86% +/- 2%, 76% +/- 2%, and 95% +/- 2% after aortic, mitral, and tricuspid valve replacement, respectively. Risk factors for reoperation were young age for aortic or mitral valve replacement, previous operation for aortic valve replacement, and large valve size for mitral valve replacement. Freedom from thromboembolism was 77% +/- 4%, 62% +/- 9%, and 80% +/- 5%; from hemorrhage, 95% +/- 5%, 87% +/- 4%, and 82% +/- 6%; and from endocarditis, 94% +/- 1%, 96% +/- 1%, and 89% +/- 5% 15 years after aortic, mitral, and tricuspid valve replacement, respectively. Risk factors for thromboembolism or hemorrhage were multiple valve replacement and age. Conclusions. The standard Carpentier-Edwards bioprosthesis continues to provide relatively low complication rates at 15 years, especially in the aortic and tricuspid positions, and especially in patients older than 60 years or with significant comorbdity. (C) 1998 by The Society of Thoracic Surgeons.