Experiences with 1643 porcine prosthetic valves in 1492 patients

Sixteen hundred and forty-three porcine prosthetic values (1102 Carpentier-Edwards, 541 Hancock) were implanted in 1492 patients at New York University Medical Center between January 1976 and June 1983. The aortic valve alone was replaced in 786 patients (53%), mitral valve alone in 556 (37%), and multiple valves in 143 patients (9.6%). Concomitant coronary artery bypass was performed in 326 patients (22%). There were 116 deaths within 30 days of operation (7.8%). Follow-up (mean: 42 months) was completed in 94% of survivors and revealed that late survival from cardiac-related death was 87% at 5 years and 81% at 7 years, with no significant difference between the Carpentier-Edwards and Hancock patients. Late thromboembolic complications, however, were significantly more frequent in Hancock patients at all intervals from 1-7 years (p less than 0.05), whether in the aortic or mitral position. Patients with coronary artery disease who had concomitant coronary bypass showed a survival from late cardiac death that did not differ significantly from that of patients undergoing valve replacement alone. Before operation, 87% of patients were in New York Heart Association Class III or IV, but after operation 80% were in Class I or II. Late anticoagulant complications, endocarditis, and valve dysfunction were relatively rare. These results from a series of such size, duration, and representative numbers of two types of porcine bioprosthesis confirm excellent results with porcine prostheses in the first 4-5 years following operation.