Aspire porcine bioprosthesis: ten years' experience.
OBJECTIVE
Clinical results of this multicenter study of the Aspire porcine valve were reported previously at eight years; the present report provides an update of valve performance to 10 years postoperatively.


METHODS
A total of 749 patients (60% males; mean age 73+/-7 years) underwent implantation with the Aspire (Tissuemed) porcine bioprosthesis between 1991 and 2002, at three institutions. Follow up was complete for 98% of the cohort. The mean follow up period was 51.6+/-39.6 months (range: 0-181 months); total follow up was 3,159 patient-years (pt-yr).


RESULTS
There were 617 aortic valve replacements (AVR), 96 mitral valve replacements (MVR) and 32 double valve replacements. There were 62 deaths (8.3%), one of which was valve-related. The late mortality rate was 9.3% per pt-yr (1.2%/pt-yr valve-related). Actuarial freedom from complications at 10 years was: thromboembolism 76+/-4% (2.6%/pt-yr); hemorrhage 73+/-4% (2.8%/pt-yr); structural valve deterioration (SVD) 96+/-2% (0.2%/pt-yr); non-structural deterioration 99+/-1% (0.1%/pt-y); prosthetic valve endocarditis 97+/-1% (0.3%/pt-yr); and reoperation 97+/-1% (0.4%/pt-yr). In patients aged >70 years, the 10-year actuarial freedom from SVD was 98+/-2% for AVR and 93+/-7% for MVR. Preoperative atrial fibrillation (AF) was a significant predictor of late mortality (p <0.001), thromboembolism (p = 0.05) and hemorrhage (p = 0.01).


CONCLUSIONS
The Aspire porcine bioprostheses is a reliable choice for a tissue valve, for both the aortic and mitral positions, especially in patients aged >70 years. In elderly patients the presence of AF is a significant predictor of early and late mortality and morbidity.
Hadjinikolaou
Leonidas
L
Glenfield Hospital, Leicester, UK. LH63@le.ac.uk
Boehm
Maria C
MC
Ganner
Catherine
C
Kendall
Simon W
SW
Rosin
Michael D
MD
Goldsmith
Ira R
IR
Spyt
Tom J
TJ
D000367:Age Factors; D000368:Aged; D001705:Bioprosthesis; D004697:Endocarditis, Bacterial / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D016019:Survival Analysis; D013923:Thromboembolism / Q000209:etiology