Heart valve replacement--a report of 8- to 17-year follow-up

Forty-six heart valve prostheses were implanted in 37 patients from November 1974 to December 1982 at National Fukuoka Higashi Hospital. The patients consisted of 18 males and 19 females, with ages ranging from 14 to 66, mean 44.8 years. Bioprosthesis was used in 89.2% of the patients. There was no hospital death among the 30 single valve replacements, but one of the 7 patients receiving mitral and aortic double valve replacements died. The discharged survivors were followed up from a minimum of 8 to a maximum of 16 years (mean 9.3 years) with a cumulative follow-up period of 334.1 years with 100% completion. The actuarial survival rate at 13 years was 95 +/- 6% for mitral valve replacement (MVR), 71 +/- 17% for aortic valve replacement (AVR), and 58 +/- 19% for mitral and aortic double valve replacement (DVR), including 1 mitral and tricuspid valve replacement. This rate for overall cases was 40 +/- 29% at 17 years. Structural valve deterioration of the bioprosthesis occurred in 7 patients at the incidence of 2.4%/patient-year. The reoperation free percentage was 77 +/- 10% at 13 years in the Hancock porcine bioprosthesis (Hancock) group and 50 +/- 23% at 9 years in the Carpentier-Edwards porcine bioprosthesis (Carpentier-Edwards) group. Valve thrombosis was encountered in one case having Björk-Shiley aortic valve prosthesis with a linearized rate of 3.3%/patient-year in the group. A long-term follow-up study showed an increasing incidence of structural valve deterioration in the bioprosthesis group and thromboembolic complications in all types of prosthesis.