title: Long-term results after Carpentier-Edwards pericardial aortic valve implantation, with attention to the impact of age.
abstract: BACKGROUND
  The purpose of this study was to determine long-term patient survival and valve durability for Carpentier-Edwards pericardial valves (Edwards Lifesciences) implanted in the aortic position, with specific attention to the impact of patient age.
  
  
  METHODS
  We performed a retrospective cohort study of 2168 patients who underwent implantation of a Carpentier-Edwards pericardial aortic valve between 1991 and 2008. The mean follow-up time was 4.5 years. Primary outcomes of interest were mortality and valve explantation. Survival curves and event-free curves were obtained with the Kaplan-Meier method and compared with the log-rank test.
  
  
  RESULTS
  Survival was 92% at 1 year, 73% at 5 years, 38% at 10 years, and 18% at 15 years. Although the mortality rate of younger patients was worse than in the general population, older patients had significantly better survival than their contemporaries. Age was the independent variable most significantly associated with explantation. There was an early hazard phase for patients between 21 and 49 years of age, such that the freedom from explantation was 89% at 3 years. By 10 years, the freedom from explantation was 58% for patients 21 to 49 years of age, compared with 68% for patients 50 to 64 years, 93% for patients 65 to 74 years, and 99% for patients 75 years of age and older.
  
  
  CONCLUSIONS
  We found good long-term survival and durability. Older patients had excellent freedom from explantation, whereas younger patients fared worse. As our population ages, this information becomes increasingly important. Assessing the durability of this pericardial aortic valve may aid in predicting the durability of the transcatheter aortic valves that share the same leaflets.
authors.affiliation: Medical Data Research Center, Providence Health and Services, Portland, Oregon 97225, USA. karl.welke@multicare.org
authors.forename: Karl F
authors.initials: KF
authors.lastname: Welke
authors.forename: Yingxing
authors.initials: Y
authors.lastname: Wu
authors.forename: Gary L
authors.initials: GL
authors.lastname: Grunkemeier
authors.forename: Aftab
authors.initials: A
authors.lastname: Ahmad
authors.forename: Albert
authors.initials: A
authors.lastname: Starr
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009922:Oregon / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate