Experience with the selective use of the Carpentier-Edwards bioprosthesis

Between April, 1977, and November 1984, 136 porcine bioprosthetic valves were implanted in 122 patients principally selected on the basis of age and contraindication to anticoagulants. The following procedures were carried out: aortic valve replacement (AVR) 88, pulmonary valve replacement (PVR) 1, mitral valve replacement (MVR) 38, and tricuspid valve replacement (TVR) 9. The ages ranged from 25 to 84 years (mean 64.6 years). The 30-day mortality was 11.5% overall. Survivors were followed up to 7 years (mean 29.2 months). Actuarial survival rates at 5 years, including operative deaths, were as follows: AVR 76.2 +/- 9.3%, MVR 59.7 +/- 12.6% and combined valve replacement (CVR) 47.1 +/- 19.4%. The 5-year probability of freedom from valve-related complications was 76.8 +/- 6.9% for all patients. The rate of thromboembolic events was 3.80% per patient-year after AVR and 2.72% per patient-year after MVR and CVR. The embolic rate did not differ between patients treated with anticoagulants and those treated with platelet antiaggregators. Primary tissue valve failure occurred in 2 patients for a linear incidence of 0.77% per patient-year. Postoperative echocardiography was performed in 83% of the survivors. Patients are now prospectively followed up by bidimensional echography and pulsed Doppler in order to detect early valvular dysfunction. The performance of the Carpentier-Edwards porcine bioprosthesis is, thus, satisfactory in this group of elderly patients.