Spontaneous and time-related degeneration of Carpentier-Edwards bioprosthesis in mitral position

To assess the spontaneous and time-related degeneration of the Carpentier-Edwards (C-E) bioprosthesis at 13 years after implantation, the cases of 48 patients who had undergone mitral valve replacement with C-E bioprosthesis are examined. The time-related clinical findings were started from a new rumbling murmur at an average of 5.9 years. The time-related change of transmitral flow was assessed by pressure half time and peak pressure gradient on pulsed Doppler cardiography, and pressure gradient and effective mitral valve area on cardiac catheterization. These values were expressed as an identical linearized curve: pressure half time Y = 13.3 X +41.9, peak pressure gradient Y = 1.47 X +1.25, pressure gradient Y = 1.90 X -3.79, mitral valve area Y = -0.87 X +1.39. From the combined evidence presented by these results, the initial structural deterioration of C-E bioprosthesis is stenotic change of the cusp, not tear or laceration, and correlates well in length of implantation, as evidenced by a linear curve. We are encouraged that the lack of catastrophic prosthetic valve failure, as has been associated with the pericardial valve, affords the opportunity for an elective safe reoperation.