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The Journal of Thoracic and Cardiovascular Surgery, Vol 91, 910-917, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
RS Hartz, EB Fisher, B Finkelmeier, A DeBoer, JH Sanders Jr, JM Moran and LL Michaelis
A total of 589 porcine bioprostheses were implanted in 509 patients from
January, 1976, through December, 1983. Of the valves implanted, 390 were
Hancock and 199 were Carpentier-Edwards. A total of 1,633 patient-years was
accrued, with a mean follow-up of 38 months per patient. Two hundred eight
patients had aortic valve replacement, 209 had mitral valve replacement,
and 79 had multiple valve replacements, of which 46 were aortic and mitral
replacements. The mortality for isolated aortic valve replacement was 5.8%;
for isolated mitral replacement, 8.6%, and for all patients, 10.9%. Late
mortality was 3.9% per patient-year. The actuarial survival rate at 5 years
was 79% for aortic, 68% for mitral, and 76% for aortic-mitral valve
replacement. There were 12 thromboembolic events (0.73% per patient-year).
Two episodes occurred in patients with an aortic bioprosthesis, nine in
patients with a porcine mitral valve, and one in a patient with mitral and
tricuspid bioprosthetic valves. The probability of remaining free of
thromboembolism at 5 years was 99% for the group having aortic valve
replacement, 93% for those having mitral replacement, and 100% for the
group having aortic-mitral valve replacements. Thirteen episodes of
endocarditis occurred (0.8% per patient-year). Seven of the 13 patients
died as a direct result of endocarditis. The probability of remaining free
of prosthetic endocarditis at 5 years was 97% for the aortic valve
replacement group, 95% for the mitral group, and 97% for the aortic- mitral
group. There were 20 instances of xenograft failure (1.2% per
patient-year). The probability of remaining free of valve failure at 5
years was 96% for the aortic valve replacement group, 93% for the mitral
group, and 93% for the aortic-mitral replacement group. Primary tissue
failure of a prosthesis occurred in seven patients, all with Hancock valves
(0.43% per patient-year). As yet there has been no primary tissue failure
of the Carpentier-Edwards prosthesis. There also appears to be a lower
incidence of thromboembolism (Edwards, 0.3% per patient-year; Hancock, 0.8%
per patient-year) and endocarditis (Edwards, 0.6% per patient-year;
Hancock, 1.0% per patient-year). The low incidence of complications with
the porcine bioprosthetic valve, especially the Carpentier-Edwards,
encourages us to recommend its continued use, especially in situations in
which anticoagulation is contraindicated.
ARTICLES
An eight-year experience with porcine bioprosthetic cardiac valves
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