Carpentier-Edwards pericardial bioprosthesis in aortic or mitral position: A 12-year experience

Background. The first generation of pericardial valves was withdrawn from the market for a high rate of premature failure. With an original design, Carpentier-Edwards pericardial valves promised improved results. Methods. Seven hundred eighty-seven patients who underwent isolated aortic valve replacement and 182 patients who underwent isolated mitral valve replacement between July 1984 and December 1995 with Carpentier-Edwards pericardial bioprostheses in our institution were followed up. The patients' mean age was 68.3 (aortic valve replacement, AVR) and 63.9 (mitral valve replacement, MVR) years. All but five AVR patients were followed up for an average of 4.7 years after operation, with a total follow-up of 3,624 patient-years. All patients with MVR were followed up for an average of 5.3 years after operation, with a total follow-up of 969 patient-years. Results. After 12 years, actuarial survival rate is 53% for AVR and 54% for MVR. Freedom from valve-related complications for aortic versus mitral valve replacement is, respectively, 68% and 55%, freedom from valve-related death is 84% and 85%, freedom from thromboembolism 87% and 94%, and freedom from endocarditis 97% and 94%. The behavior of the aortic valve is better than that of the mitral valve: freedom from reoperation is 92% and 76%, respectively; freedom from valve failure is 94% and 78%. Age is an important factor, especially in the mitral position: freedom from valve failure is 52% in patients younger than 60 years and 100% in patients older than 60 years. Conclusions. With a low rate of valve-related events at 12 years and a low rate of structural deterioration, this prosthesis is a reliable choice for AVR and in patients over 60 years for MVR. A more durable mitral bioprosthesis is needed for patients younger than 60 years. (C) 1998 by The Society of Thoracic Surgeons.