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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 238-251, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
TA Burdon, DC Miller, PE Oyer, RS Mitchell, EB Stinson, VA Starnes and NE Shumway
Isolated aortic (n = 857) or mitral (n = 793) valve replacement with a
porcine bioprosthesis was performed in 1650 patients between 1971 and 1980.
Follow-up (total = 12,012 patient-years) extended to more than 15 years and
was 96% complete. Patient age ranged from 16 to 87 years; mean age was 59
+/- 11 years (+/- 1 standard deviation) for the aortic valve replacement
cohort and 56 +/- 12 years for the mitral valve replacement cohort. The
operative mortality rates were 5% +/- 1% (+/- 70% confidence limits) and 8%
+/- 1%, respectively, for the aortic and mitral subgroups. Estimated
freedom from structural valve deterioration (+/- 1 standard error of the
mean) after 10 and 15 years was significantly higher for the aortic than
for the mitral valve replacement subgroup (85% +/- 0.4% and 63% +/- 3%
versus 78% +/- 2% and 45% +/- 3%, respectively, p = 0.001).
Reoperation-free actuarial estimates were also significantly greater for
the aortic valve replacement cohort: 83% +/- 2% and 57% +/- 3% versus 78%
+/- 2% and 43% +/- 3% for mitral valve replacement at 10 and 15 years,
respectively. The mortality rate for reoperative aortic valve replacement
was 11% +/- 1%; it was 8% +/- 1% for reoperative mitral valve replacement.
Importantly, the estimates of freedom from valve-related death (including
sudden, unexplained deaths) were relatively high at 10 and 15 years: 78%
+/- 2% and 69% +/- 3% in the aortic cohort and 74% +/- 2% and 63% +/- 3% in
the mitral cohort (p = not significant). Excluding sudden, unexplained
deaths, these estimates were 81% +/- 3% (aortic) and 73% +/- 4% (mitral) at
15 years. Thromboembolism-free rates were 84% +/- 3% (aortic) and 78% +/-
6% (mitral) at 15 years, and freedom from anticoagulant-related hemorrhage
was 96% +/- 1% and 89% +/- 2%, respectively. At the time of current
follow-up, 13% of patients having aortic valve replacement and 50% of
patients having mitral valve replacement were receiving warfarin sodium.
The hazard functions for thromboembolism and prosthetic valve endocarditis
were constant and remained less than 1%/pt-yr over the entire follow-up
period.(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
Durability of porcine valves at fifteen years in a representative North American patient population
Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, CA 94305-5247.
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 K. E. Hammermeister, G. K. Sethi, W. G. Henderson, C. Oprian, T. Kim, S. Rahimtoola, and The Veterans Affairs Cooperative Study on Valvular A Comparison of Outcomes in Men 11 Years after Heart-Valve Replacement with a Mechanical Valve or Bioprosthesis N. Engl. J. Med., May 6, 1993; 328(18): 1289 - 1296. [Abstract] [Full Text]
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