Long-term Results after Carpentier-Edwards Pericardial Aortic Valve Implantation, with Attention to the Impact of Age
DOI:
https://doi.org/10.1532/HSF98.20101140Abstract
Background: The purpose of this study was to determine long-term patient survival and valve durability for Carpentier-Edwards pericardial valves (Edwards Lifesciences) implanted in the aortic position, with specific attention to the impact of patient age.
Methods: We performed a retrospective cohort study of 2168 patients who underwent implantation of a Carpentier-Edwards pericardial aortic valve between 1991 and 2008. The mean follow-up time was 4.5 years. Primary outcomes of interest were mortality and valve explantation. Survival curves and event-free curves were obtained with the Kaplan-Meier method and compared with the log-rank test.
Results: Survival was 92% at 1 year, 73% at 5 years, 38% at 10 years, and 18% at 15 years. Although the mortality rate of younger patients was worse than in the general population, older patients had significantly better survival than their contemporaries. Age was the independent variable most significantly associated with explantation. There was an early hazard phase for patients between 21 and 49 years of age, such that the freedom from explantation was 89% at 3 years. By 10 years, the freedom from explantation was 58% for patients 21 to 49 years of age, compared with 68% for patients 50 to 64 years, 93% for patients 65 to 74 years, and 99% for patients 75 years of age and older.
Conclusion: We found good long-term survival and durability. Older patients had excellent freedom from explantation, whereas younger patients fared worse. As our population ages, this information becomes increasingly important. Assessing the durability of this pericardial aortic valve may aid in predicting the durability of the transcatheter aortic valves that share the same leaflets.
References
Akins CW, Miller DC, Turina MI, et al. 2008. Guidelines for reporting morbidity and mortality after cardiac valve interventions. Ann Thorac Surg 85:1490-5.nAupart M, Babuty D, Neville P, Fauchier L, Sirinelli A, Marchan M. 1997. Influence of age on valve related events with Carpentier-Edwards pericardial bioprosthesis. Eur J Cardiothorac Surg 11:929-34.nAupart MR, Mirza A, Meurisse YA, Sirinelli AL, Neville PH, Marchand MA. 2006. Perimount pericardial bioprosthesis for aortic calcified stenosis: 18-year experience with 1133 patients. J Heart Valve Dis 15:768-75.nBanbury MK, Cosgrove DM 3rd, Lytle BW, Smedira NG, Sabik JF, Saunder CR. 1998. Long-term results of the Carpentier-Edwards pericardial aortic valve: a 12-year follow-up. Ann Thorac Surg 66(suppl):S73-6.nBanbury MK, Cosgrove DM 3rd, White JA, Blackstone EH, Frater RW, Okies JE. 2001. Age and valve size effect on long-term durability of the Carpentier-Edwards aortic pericardial bioprosthesis. Ann Thorac Surg 72:753-7.nBiglioli P, Spampinato N, Cannata A, et al. 2004. Long-term outcomes of the Carpentier-Edwards pericardial valve prosthesis in the aortic position: effect of patient age. J Heart Valve Dis 13(suppl 1):S49-51.nBonow RO, Carabello BA, Chatterjee K, et al. 2008. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease): endorsed by the Society of Cardiovascular Anethesiologists, Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons. Circulation 118:e523-661.nBrown ML, Schaff HV, Lahr BD, et al. 2008. Aortic valve replacement in patients aged 50 to 70 years: improved outcomes with mechanical versus biologic prostheses. J Thorac Cardiovasc Surg 135:878-84.nCosgrove DM, Lytle BW, Taylor PC, et al. 1995. The Carpentier-Edwards pericardial aortic valve. Ten-year results. J Thorac Cardiovasc Surg 110:651-2.nDavierwala PM, Borger MA, David TE, Rao V, Maganti M, Yau TM. 2006. Reoperation is not an independent predictor of mortality during aortic valve surgery. J Thorac Cardiovasc Surg 131:329-35.nDellgren G, David TE, Raanani E, Armstrong S, Ivanov J, Rakowski H. 2002. Late hemodynamic and clinical outcomes of aortic valve replacement with the Carpentier-Edwards Perimount pericardial bioprosthesis. J Thorac Cardiovasc Surg 124:146-54.nLaPar DJ, Yang Z, Stukenborg GJ, et al. 2010. Outcomes of reoperative aortic valve replacement after previous sternotomy. J Thorac Cardiovasc Surg 139:263-72.nMcClure RS, Narayanasamy N, Wiegerinck E, et al. 2010. Late outcomes for aortic valve replacement with the Carpentier-Edwards pericardial bioprosthesis: up to 17-year follow-up in 1,000 patients. Ann Thorac Surg 89:1410-6.nPelletier LC, Carrier M, Leclerc Y, Dryda I. 1995. The Carpentier-Edwards pericardial bioprosthesis: clinical experience with 600 patients. Ann Thorac Surg 60(suppl):S297-302.nPotter DD, Sundt TM 3rd, Zehr KJ, et al. 2005. Operative risk of reoperative aortic valve replacement. J Thorac Cardiovasc Surg 129:94-103.nRizzoli G, Bejko J, Bottio T, Tarzia V, Gerosa G. 2010. Valve surgery in octogenarians: does it prolong life? Eur J Cardiothorac Surg 37:1047-55.nRodés-Cabau J, Webb JG, Cheung A, et al. 2010. Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience. J Am Coll Cardiol 55:1080-90.nSchelbert EB, Vaughn-Sarrazin MS, Welke KF, Rosenthal GE. 2005. Hospital volume and selection of valve type in older patients undergoing aortic valve replacement surgery in the United States. Circulation 111:2178-82.nStoica SC, Cafferty F, Kitcat J, et al. 2006. Octogenarians undergoing cardiac surgery outlive their peers: a case for early referral. Heart 92:503-6.nU.S. Census Bureau. United States Census 2000. Available at: http://www.census.gov/main/www/cen2000.html'>http://www.census.gov/main/www/cen2000.htmlnvan Geldorp MWA, Jamieson WRE, Kappetein AP, et al. 2009. Patient outcome after aortic valve replacement with a mechanical or biological prosthesis: weighing lifetime anticoagulant-related event risk against reoperation risk. J Thorac Cardiovasc Surg 137:881-6, 886e1-5.nWalther T, Falk V, Borger MA, et al. 2009. Transapical aortic valve implantation in patients requiring redo surgery. Eur J Cardiothorac Surg 36:231-4.nWalther T, Falk V, Dewey T, et al. 2007. Valve-in-a-valve concept for transcatheter minimally invasive repeat xenograft implantation. J Am Coll Cardiol 50:56-60.nYe J, Cheung A, Lichtenstein SV, et al. 2010. Transapical transcatheter aortic valve implantation: follow-up to 3 years. J Thorac Cardiovasc Surg 139:1107-13.n
