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The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 543-561, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
WR Jamieson, P Allen, RT Miyagishima, AN Gerein, AI Munro, LH Burr and GF Tyers
The Carpentier-Edwards standard porcine bioprosthesis was implanted in 1190
patients (1201 operations, 1303 valves) between January 1975 and June 1986;
most implants were before 1982. The mean age of the patients was 57.2 years
(range 8 to 85 years). The early mortality was 7.6% (aortic valve
replacement 5.1%, mitral valve replacement 8.8%, and multiple valve
replacement 15.3%). Late mortality was 3.9% per patient- year (aortic valve
replacement 3.6%, mitral valve replacement 4.2%, and multiple valve
replacement 3.8%). The total cumulative follow-up period was 6737 years.
Thromboembolism was 1.5% per patient-year (fatal 0.4% per patient-year)
(minor 0.6%, major 0.9%); antithromboembolic therapy- related hemorrhage
was 0.5% (fatal 0.1%); prosthetic valve endocarditis was 0.6% (fatal 0.2%);
nonstructural dysfunction was 0.5% (fatal 0.2%); and structural valve
deterioration and/or primary tissue failure was 1.5% per patient-year
(fatal, 0.2% per patient-year). Thromboembolism and structural valve
deterioration were the significant complications, structural valve
deterioration occurring primarily between the sixth and 10th year of
evaluation. The overall patient survival was 65.0% for aortic valve
replacement and 54.8% for mitral valve replacement (p less than 0.05) at 10
years. The patients were classified as 92.9% New York Heart Association
functional classes III and IV preoperatively and 92.3% classes I and II
postoperatively. Freedom at 10 years from thromboembolism was 84.3% for
aortic valve replacement and 76.5% for mitral valve replacement (p = 0.05);
structural valve deterioration was 78.6% for aortic valve replacement and
71.6% for mitral valve replacement (p less than 0.05); reoperation was
74.4% for aortic valve replacement and 67.1% for mitral valve replacement
(p less than 0.05). Freedom from all valve-related complications at 10
years was 58.9% for aortic valve replacement and 46.8% for mitral valve
replacement (p less than 0.05); valve-related mortality was 89.5% for
aortic valve replacement and 82.6% for mitral valve replacement (p = not
significant); mortality and reoperation was 58.9% for aortic valve
replacement and 46.8% for mitral valve replacement (p less than 0.05);
mortality and residual morbidity (treatment failure) was 87.2% for aortic
valve replacement and 75.1% for mitral valve replacement (p = not
significant); mortality, residual morbidity, and reoperation were 66.3% for
aortic valve replacement and 54.9% for mitral valve replacement (p less
than 0.05). The standard Carpentier-Edwards porcine bioprosthesis has
provided satisfactory clinical performance and has afforded patients
excellent quality of life.
ARTICLES
The Carpentier-Edwards standard porcine bioprosthesis. A first- generation tissue valve with excellent long-term clinical performance
Department of Surgery, University of British Columbia, Vancouver, Canada.
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