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The Journal of Thoracic and Cardiovascular Surgery, Vol 73, 54-63, Copyright © 1977 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
EB Stinson, RB Griepp, PE Oyer and NE Shumway
Between 1971 and 1975, glutaraldehyde-preserved porcine aortic valve
xenografts were employed for isolated replacement of the mitral valve (MVR)
in 243 patients, replacement of the aortic valve (AVR) in 167 patients, and
double valve replacement (AVR and MVR) in 51 patients. Postoperatively,
long-term anticoagulation was not routinely given. Operative mortality
rates for AVR, MVR, and double valve groups were 7.8, 6.0, and 11.8 per
cent, respectively; the majority of early postoperative deaths were
associated with concomitant coronary artery disease. No death was
attributable to xenograft dysfunction. Follow-up of all patients was
obtained. The total duration of follow-up for the MVR group was 347
patient-years, for the AVR GROUP 148 148 patient- years, and for double
valve replacement 37 patient-years; maximum follow-up for these three
groups was 4.4, 4.0, and 2.4 years, respectively. Actuarial analysis of
postoperative survival rates at a common interval of 3 years showed 78 per
cent for MVR patients, 91 per cent for AVR patients, and 80 per cent
(projected) for patients with double valve replacement (85, 96, and 91 per
cent for operative survivors, respectively. At this same interval 92 per
cent of MVR patients, 99 per cent of AVR patients, and 93 per cent
(projected) of patients with double valve replacement were free of
thromboembolic episodes. Altogether, 12 of the total 512 valves implanted
exhibited some evidence of dysfunction during the entire period of
follow-up evaluation, but in only 2 instances (both mitral) was intrinsic
pathological involvement of the xenograft tissue documented. Actuarial
analysis of xenograft dysfunction at a common interval of 3 years after
operation showed 95 per cent of MVR patients, 98 per cent of AVR patients,
and 97 per cent (projected) of patients with double valve replacement to be
free of this complication. These data support the use of
glutaraldehyde-preserved porcine xenografts as superior bioprostheses that
pose a low risk of thromboembolism without anticoagulation. The over-all
durability of such valves, within the restriction of a maximum current
follow-up interval of 4.4 years, appears comparable to that of currently
available mechanical prostheses and justifies continued clinical use.
ARTICLES
Long-term experience with porcine aortic valve xenografts
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