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Published on: May 21, 2017
Experience with 813 aortic or mitral valve replacements with the Carpentier-Edwards bioprosthesis: Five year results
Insights
The Carpentier-Edwards bioprosthesis demonstrated favorable outcomes in 813 patients undergoing aortic (AVR) and mitral valve replacement (MVR). Low rates of thromboembolism and tissue failure suggest bioprosthetic valves are a viable option for long-term cardiac health.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Prosthetic Heart Valves
Background:
- Bioprosthetic heart valves are crucial for treating valvular heart disease.
- The Carpentier-Edwards bioprosthesis has been widely used, necessitating long-term outcome evaluation.
- Understanding complication rates and survival is vital for patient selection and management.
Purpose of the Study:
- To assess the long-term efficacy and safety of the Carpentier-Edwards bioprosthesis.
- To evaluate operative mortality, late survival, and complication rates (thromboembolism, bleeding, valve failure) after aortic valve replacement (AVR) and mitral valve replacement (MVR).
Main Methods:
- Retrospective analysis of 813 patients who received Carpentier-Edwards bioprosthetic valves between 1976 and 1983.
- Classification of late mortality and complications using Stanford Group criteria.
- Actuarial survival analysis and calculation of complication rates per patient-year (pt yr).
Main Results:
- Operative mortality: 5.49% for AVR, 4.59% for MVR.
- 5-year actuarial survival: 87.9% +/- 2.7% for AVR, 91.1% +/- 1.4% for MVR.
- Low rates of thromboembolism (0.48% pt yr AVR, 0.90% pt yr MVR) and valve failure (2.04% pt yr AVR, 1.55% pt yr MVR) were observed.
- Reoperation rates for tissue failure were low (0.24% pt yr AVR, 0.32% pt yr MVR).
Conclusions:
- The Carpentier-Edwards bioprosthesis offers a favorable balance of low thromboembolic events and acceptable valve failure rates at 5 years.
- The benefits of reduced thromboembolism outweigh the specific risks associated with bioprosthetic valves in this cohort.
- These findings support the continued use of bioprosthetic valves in selected patients requiring aortic and mitral valve replacement.
Abstract:
813 patients underwent aortic (AVR) or mitral valve replacement using the Carpentier-Edwards bioprosthesis from 1976 to 1983. Operative mortality was 5.49% for AVR and 4.59% for MVR. Late mortality and complications were classified using criteria described by the Stanford Group. Actuarial survival at 5 years was 87.9% +/- 2.7% for AVR and 91.1% +/- 1.4% in MVR. Thromboembolism occurred at low rates of 0.48% pt yr for AVR and 0.90% pt yr for MVR. 98.2% +/- 0.90% of AVR and 96.9% +/- 1.3% of MVR pts were free from thromboembolism at 5 years. The low incidence of thromboembolism during the early postoperative period played a role in the low rates observed in the complete study. There was no valve thrombosis. Anticoagulation with warfarin was used in 35% AVR and 75% MVR with rates of bleeding complications of 1.20% pt yr and 1.10% pt yr. Overall valve failure rate was 2.04% pt yr at 5 years for AVR and 1.55% pt yr for MVR. Rates of reoperation for tissue failure remained low (0.24% pt yr for AVR and 0.32% pt yr for MVR). The advantage of a low rate of thromboembolism was not outweighed by the specific problems of bioprosthesis at 5 years.
