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The Journal of Thoracic and Cardiovascular Surgery, Vol 83, 493-502, Copyright © 1982 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
WW Angell, JD Angell and JC Kosek
Three hundred fifty-two patients underwent aortic (AVR) or mitral (MVR)
valve replacement with a glutaraldehyde-preserved porcine xenograft from
1970 to 1980. Analysis of this series revealed the following information:
hospital mortality, 11.6% (41/352); late mortality, 5.5% per patient-year
(60/1,090.7); actuarial 5 year survival rate, 70%; incidence of
thromboembolism and hemorrhage, 1.4% per patient-year (15/1,090.7);
incidence of spontaneous degeneration, 1.1% per patient- year (12/1,090.7);
and transvalvular gradient. AVR 16 mm Hg and MVR 4.6 mm Hg. These results
compare favorably with results from other porcine xenograft series and with
those reported for prosthetic valves. There is no apparent difference in
the type of xenograft used with the exception that spontaneous degeneration
occurred less frequently in mitral valves that had not undergone pressure
fixation than in those that had. The use of flexible stents improved the
ease of valve implantation but did not affect leaflet durability as
anticipated. Calcification occurred randomly with no relationship to time
of implantation. Reoperation was for spontaneous valve deterioration by
calcification or collagen degeneration in 11 cases, paravalvular leak in 13
cases, and implantation of an undersized valve in four cases; there was one
reoperation for infection. Results support the continued use of porcine
xenografts and suggest that improved manufacturing techniques will reduce
the incidence of spontaneous, sterile deterioration, which is the only
serious drawback to routine use of the porcine xenograft.
ARTICLES
Twelve-year experience with glutaraldehyde-preserved porcine xenografts
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