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Experience with the 19-mm Carpentier-Edwards pericardial bioprosthesis in the elderly
M Carrier1, M Pellerin, L P Perrault
1Department of Surgery and Medicine, Montreal Heart Institute, and the University of Montreal, Quebec, Canada. carrier@icm.umontreal.ca
Insights
Aortic valve replacement using the 19-mm Carpentier-Edwards pericardial bioprosthesis shows excellent midterm outcomes in elderly patients. This study compared the 19-mm size to larger prostheses, finding comparable survival and event-free rates.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Geriatric Medicine
Background:
- Aortic valve replacement in patients with small aortic roots presents unique surgical challenges.
- The Carpentier-Edwards pericardial bioprosthesis is a common choice for aortic valve replacement.
Purpose of the Study:
- To compare the midterm outcomes of the 19-mm Carpentier-Edwards pericardial bioprosthesis with larger bioprostheses in elderly patients (≥70 years).
Main Methods:
- Retrospective review of 443 elderly patients who underwent aortic valve replacement with Carpentier-Edwards pericardial bioprostheses.
- Patients were divided into two groups: those who received a 19-mm prosthesis (n=93) and those who received a larger prosthesis (n=350).
- Outcomes analyzed included 30-day mortality, 7-year survival, and 7-year freedom from valve-related events.
Main Results:
- The 19-mm group required more associated aortoplasty (11% vs. 2%, p=0.001).
- 30-day mortality was 12% for the 19-mm group versus 6% for the larger prostheses group (p=0.1).
- 7-year survival rates were 61%+/-7% for the 19-mm group and 67%+/-4% for the larger prostheses group (p=0.8).
- 7-year freedom from valve-related events was comparable: 96%+/-2% for the 19-mm group and 93%+/-2% for the larger prostheses group (p=0.6).
Conclusions:
- The 19-mm Carpentier-Edwards pericardial bioprosthesis provides excellent midterm results in elderly patients undergoing aortic valve replacement.
- This prosthesis is a viable option for patients with small aortic roots, demonstrating comparable long-term safety and efficacy to larger devices.
Background:
Valve replacement in small aortic root remains a surgical challenge. The objective of this study was to compare results of the 19-mm bioprosthesis with those of larger prostheses in the elderly.
Methods:
The 443 patients, 70 years of age and older, who underwent aortic valve replacement with Carpentier-Edwards pericardial bioprostheses were reviewed.
Results:
There were 93 patients with a mean age of 76+/-4 years with implantation of 19-mm prostheses and 350 patients with a mean age of 75+/-4 years with larger bioprostheses. Associated aortoplasty was performed in 10 patients (11%) with 19-mm bioprostheses and in 8 patients (2%) with larger bioprostheses (p = 0.001). There were 11 deaths (12%) within 30 days of surgery in patients with 19-mm prostheses and 22 deaths (6%) among those with larger prostheses (p = 0.1). The 7-year survival rate averaged 61%+/-7% in patients with 19-mm prostheses and 67%+/-4% in those with larger prostheses (p = 0.8). The 7-year freedom rates from all valve-related events averaged 96%+/-2% and 93%+/-2%, respectively (p = 0.6).
Conclusions:
Aortic valve replacement with the 19-mm Carpentier-Edwards pericardial bioprosthesis offers excellent midterm results in the elderly.
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