Age and valve size effect on the long-term durability of the Carpentier-Edwards aortic pericardial bioprosthesis.
BACKGROUND
Bioprosthesis durability decreases with time and younger age. However, the time-scale and determinants of durability of the aortic Carpentier-Edwards stented bovine pericardial prosthesis are incompletely characterized.


METHODS
Between September 1981 and January 1984, 267 patients underwent implantation of the pericardial aortic prosthesis at four centers. Mean age at implant was 65 +/- 12 years (range 21 to 86 years). Follow-up averaged 12 +/- 4.5 years. The primary end point was explant for structural valve dysfunction (SVD), which was analyzed multivariably in the context of death as a competing risk.


RESULTS
Freedom from explant due to SVD was 99%, 94%, and 77% at 5, 10, and 15 years. Risk of SVD increased exponentially with time and younger age (p = 0.0001) at implantation; an increased risk of small valve size was not reliably demonstrated (p = 0.1). Considering the competing risk of death, patients aged 65 years or older had a less than 10% chance of explant for SVD by 15 years.


CONCLUSIONS
Durability of this stented pericardial aortic bioprosthesis is excellent and justifies its use in patients aged 65 or older.
Banbury
M K
MK
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA. banburm@ccf.org
Cosgrove
D M
DM
White
J A
JA
Blackstone
E H
EH
Frater
R W
RW
Okies
J E
JE
D000206:Actuarial Analysis; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011474:Prosthesis Design; D012307:Risk Factors; D016019:Survival Analysis