Long-term Results after Carpentier-Edwards Pericardial Aortic Valve Implantation, with Attention to the Impact of Age
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.
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
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).