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The Carpentier-Edwards pericardial bioprosthesis: clinical experience with 600 patients
L C Pelletier1, M Carrier, Y Leclerc
1Department of Surgery, Montreal Heart Institute, Quebec, Canada.
Insights
The Carpentier-Edwards pericardial bioprosthesis shows excellent durability up to 10 years for aortic valve replacement. Further data is needed for mitral valve replacement long-term durability.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Outcomes Research
Background:
- Pericardial bioprostheses are widely used for heart valve replacement.
- Assessing long-term durability and complication rates is crucial for patient management.
Purpose of the Study:
- To evaluate the long-term survival, durability, and complication rates of Carpentier-Edwards pericardial bioprostheses.
- To compare outcomes across different valve positions (aortic, mitral, tricuspid, multiple).
Main Methods:
- Retrospective analysis of 600 patients undergoing Carpentier-Edwards pericardial bioprosthesis implantation.
- Kaplan-Meier survival analysis and freedom from event calculations (embolism, endocarditis, reoperation).
Main Results:
- 10-year survival rates: 70% (aortic), 62% (mitral), 57% (multiple).
- 10-year freedom from primary dysfunction: 87% (aortic), 79% (mitral), 77% (multiple).
- Higher freedom from dysfunction observed in patients >59 years old.
Conclusions:
- Carpentier-Edwards pericardial bioprosthesis demonstrates excellent durability up to 10 years in the aortic position.
- Long-term data for mitral valve use requires further investigation.
- This bioprosthesis is a preferred option when a bioprosthesis is indicated.
Abstract:
Carpentier-Edwards pericardial bioprostheses were implanted in 600 patients: 416 aortic valve replacement, 115 mitral valve replacement, 6 isolated tricuspid, and 63 multiple valve replacements. The survival rates were 70% at 10 years after aortic valve replacement, 62% 8 years after mitral valve replacement, and 57% at 8 years with multiple valve replacement. Overall, 69 patients suffered one or more valve-related complications. The 10-year freedom rates from embolism were 91% (aortic valve replacement), 92% (mitral valve replacement), and 89% (multiple valve replacement), and those from endocarditis were 95%, 93%, and 85%, respectively. In 18 of the 35 patients, reoperation was due to primary valve dysfunction. Freedom from primary dysfunction was 87% at 10 years with aortic valve replacement, and at 8 years, it was 79% with mitral valve replacement and 77% with multiple valve replacement. A direct correlation was found between freedom from valve dysfunction and age of the patient at operation, with a 10-year-free rate of 90% among patients older than 59 years. This bioprosthesis has an excellent durability up to 10 years in the aortic position. More data regarding its long-term durability in the mitral position are needed. It is currently our valve substitute of choice when a bioprosthesis is indicated.