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Aortic valve replacement with the Carpentier-Edwards pericardial bioprosthesis: clinical and hemodynamic results
L C Pelletier1, Y Leclerc, R Bonan
1Department of Surgery, Montreal Heart Institute, Quebec, Canada.
Insights
The Carpentier-Edwards bovine pericardial bioprosthesis demonstrated good long-term survival and functional improvement in aortic valve replacement patients. This bioprosthesis showed low rates of complications and effective hemodynamics, proving reliable for aortic valve surgery.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Outcomes Research
Background:
- Aortic valve replacement is a critical procedure for patients with severe aortic valve disease.
- The Carpentier-Edwards bovine pericardial bioprosthesis is a commonly used option for aortic valve replacement.
- Evaluating the long-term safety and efficacy of bioprosthetic valves is essential.
Purpose of the Study:
- To assess the long-term outcomes of isolated aortic valve replacement using the Carpentier-Edwards bovine pericardial bioprosthesis.
- To evaluate valve-related complications, survival rates, and hemodynamic performance.
- To determine the reliability and effectiveness of this bioprosthesis in clinical practice.
Main Methods:
- Retrospective analysis of 189 patients undergoing isolated aortic valve replacement.
- Follow-up for an average of 37 months (551 patient-years) to track survival and complications.
- Assessment of valve-related events including thromboembolism, endocarditis, hemorrhage, and reoperation.
- Postoperative functional class assessment, hematological evaluation for hemolysis, and hemodynamic studies.
Main Results:
- Early mortality was 4.8% (9 patients), with 18 late deaths over follow-up.
- Actuarial survival at 5 years was 81.9%.
- Key complication rates per patient-year included thromboembolism (2.2%), endocarditis (1.3%), hemorrhage (0.4%), and reoperation (0.5%).
- Five-year freedom from thromboembolism was 91%, reoperation 98%, and overall valve-related complications 87%.
- No primary tissue failure was observed.
- Significant functional improvement occurred, with 97% of survivors in NYHA Class I or II post-surgery.
- Hemodynamic studies showed acceptable pressure gradients and effective orifice areas.
- No significant hemolysis was detected.
Conclusions:
- The Carpentier-Edwards bovine pericardial bioprosthesis is a reliable and hemodynamically effective option for aortic valve replacement.
- The prosthesis offers good long-term survival and functional recovery for patients.
- Low rates of valve-related complications support its continued use in clinical practice.
Abstract:
From 1981 to 1987, 189 patients underwent isolated aortic valve replacement with the Carpentier-Edwards bovine pericardial bioprosthesis. There were 9 early deaths (30-day mortality of 4.8%) and 18 late deaths (3.3% pt-yr). After 5 years, the actuarial survival rate was 81.9%. All patients but one were followed for an average of 37 months after operation, and follow-up totaled 551 patient-years. Valve-related complications included 12 thromboembolic episodes (2.2%/pt-yr), 7 endocarditis (1.3%/pt-yr), 2 hemorrhages due to anticoagulation (0.4%/pt-yr), and 3 reoperations (0.5%/pt-yr). After five years, freedom from thromboembolic events was 91%, that from reoperation was 98%, and 87% for all valve-related complications. There was no primary tissue failure of the valve. Before operation, 55% of the patients were in functional Class III or IV, 97% of the survivors were in Class I or II after valve replacement. Hematological evaluation of 77 patients, an average of 18 months postoperatively, showed no clinically significant hemolysis. Postoperative hemodynamic studies in 28 patients showed mean aortic pressure gradients across the prosthesis at rest ranging from 24 mmHg with the smaller (19 mm) to 11 mmHg with the larger (25 mm and more) valves, and effective orifice areas ranging from 1.0 to 1.9 cm2, respectively. Thus, the Carpentier-Edwards pericardial bioprosthesis appears to be a reliable and hemodynamically effective substitute for replacement of the aortic valve.