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Twelve-year experience with the 19 mm Carpentier-Edwards pericardial aortic valve
H Nakajima1, M R Aupart, P H Neville
1Department of Cardiac Surgery, Trousseau Hospital, Tours, France.
Insights
The Carpentier-Edwards pericardial valve demonstrates good durability and clinical performance in patients with small aortic annuli. This 12-year study confirms its reliability for aortic valve replacement in this challenging patient group.
Area of Science:
- Cardiac Surgery
- Biomaterials Science
- Medical Devices
Background:
- Small aortic annuli present challenges for prosthesis selection, requiring consideration of hemodynamics and long-term valve durability.
- The Carpentier-Edwards pericardial valve is recognized for its favorable hemodynamic profile and proven durability.
- This study evaluates the 12-year outcomes of patients receiving a 19 mm Carpentier-Edwards pericardial prosthesis for small aortic annuli.
Purpose of the Study:
- To assess the long-term clinical performance and durability of the 19 mm Carpentier-Edwards pericardial bioprosthesis in patients with small aortic annuli.
- To evaluate hemodynamic outcomes, survival rates, and valve-related complications over a 12-year follow-up period.
Main Methods:
- A retrospective review of 121 patients who underwent isolated aortic valve replacement with a 19 mm Carpentier-Edwards pericardial bioprosthesis between 1984 and 1995.
- Patients were followed for an average of 4.84 years, with a total follow-up of 581 patient-years.
- Outcomes assessed included operative mortality, functional status (NYHA class), hemodynamic parameters (gradient, effective orifice area), survival, and valve-related complications.
Main Results:
- Operative mortality was 3.3%. At 12 years, actuarial survival was 42%.
- 86% of surviving patients were in NYHA class I or II, with a mean gradient of 18.0 mmHg and effective orifice area of 1.1 cm².
- At 12 years, freedom from reoperation was 89%, freedom from valve failure was 92%, and freedom from valve-related death was 61%.
Conclusions:
- The Carpentier-Edwards pericardial prosthesis demonstrates a low rate of structural valve failure at 12 years.
- The prosthesis offers good clinical performance, making it a reliable option for patients with small aortic annuli.
- Long-term data supports the use of this bioprosthesis in selected patients requiring aortic valve replacement due to small annulus size.
Background And Aims Of The Study:
In patients with small aortic annuli, the choice of prosthesis should be based on hemodynamics and valve durability. The Carpentier-Edwards pericardial valve offers good hemodynamic performance and long-term valve durability. We reviewed our 12-year experience with 121 patients who received a 19 mm prosthesis.
Methods:
A total of 121 patients (97 females, 24 males; mean age 73.2 +/- 9.4 years) underwent isolated aortic valve replacement with a 19 mm Carpentier-Edwards pericardial bioprosthesis in our institution between July 1984 and December 1995. Patients were followed up for an average of 4.84 years after surgery; total follow up was 581 patient-years (pt-yr).
Results:
The operative mortality rate was 3.3% (4/121). At the present time, 77 patients (86%) are in NYHA class I or II with a mean gradient of 18.0 +/- 6.9 mmHg and mean effective orifice area 1.1 +/- 0.23 cm2. There were 25 late deaths. After 12 years the actuarial survival rate was 42 +/- 26%. Eight patients died of valve-related cause (one endocarditis, one structural failure, two thromboembolisms, one anticoagulant-related hemorrhage, three sudden deaths). At 12 years, the actuarial rate of freedom from valve-related death was 61 +/- 37% and from non-sudden valve-related death 88 +/- 11%. Valve-related complications included six thromboembolic episodes (1.0%/pt-yr), one endocarditis (0.17%/pt-yr), two reoperations (0.34%/pt-yr) and two structural valve failures (0.34%/pt-yr). After 12 years, freedom from reoperation was 89 +/- 11%, from valve failure 92 +/- 8%, from thromboembolic episodes 82 +/- 16% and from endocarditis 99 +/- 1%.
Conclusion:
With a low rate of structural valve failure at 12 years and a good clinical performance, the Carpentier-Edwards prosthesis is a reliable alternative for small aortic annuli.