title: Very long-term outcomes of the Carpentier-Edwards Perimount valve in aortic position.
abstract: BACKGROUND
  The Carpentier-Edwards Perimount pericardial bioprosthesis (Edwards Lifesciences, Irvine, CA) has demonstrated good long-term outcomes, but its durability remains unclear depending on age at implantation. We report our 20-year experience with the Perimount valve implanted in the aortic position, with particular attention to the probability and time to reoperation required due to bioprosthesis deterioration.
  
  
  METHODS
  From 1984 to 2008 at our center, 2,659 patients (mean age, 70.7 ± 10.4 years) underwent aortic valve replacement using the Perimount pericardial bioprostheses. Patients were prospectively followed on an annual basis (mean 6.7 ± 4.8 years, range 0 to 24.6 years) with an echocardiogram at the time of follow-up. Cumulative follow-up was 18,404 valve-years. Bioprosthesis structural valve deterioration was determined by strict echocardiographic assessment.
  
  
  RESULTS
  Overall operative mortality was 2.8%. Actuarial survival rates including early deaths averaged 52.4% ± 1.2%, 31.1% ± 1.4%, and 14.4% ± 1.7% after 10, 15, and 20 years of follow-up, respectively. Age-stratified freedom from reoperation due to structural valve deterioration at 15 and 20 years was 70.8% ± 4.1% and 38.1% ± 5.6%, respectively, for the group aged 60 years or less, 82.7% ± 2.9% and 59.6% ± 7.6% for those 60 to 70 years, and 98.1% ± 0.8% at 15 years and above for the oldest group. Expected valve durability is 19.7 years for the entire cohort.
  
  
  CONCLUSIONS
  With a low rate of valve-related events at 20 years, and particularly a low rate of structural valve deterioration, the Carpentier-Edwards Perimount pericardial bioprosthesis remains a reliable choice for a tissue valve in the aortic position, especially in patients over 60 years of age.
authors.affiliation: Department of Cardiac Surgery, Tours University Hospital, France. Electronic address: thierry-bourguignon@hotmail.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Bourguignon
authors.affiliation: Department of Cardiac Surgery, Tours University Hospital, France.
authors.forename: Anne-Lorraine
authors.initials: AL
authors.lastname: Bouquiaux-Stablo
authors.affiliation: Department of Biostatistics, Edwards Lifesciences, Nyon, Switzerland.
authors.forename: Pascal
authors.initials: P
authors.lastname: Candolfi
authors.affiliation: Department of Cardiac Surgery, Tours University Hospital, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Mirza
authors.affiliation: Department of Cardiac Surgery, Tours University Hospital, France.
authors.forename: Claudia
authors.initials: C
authors.lastname: Loardi
authors.affiliation: Department of Cardiac Surgery, Tours University Hospital, France.
authors.forename: Marc-Antoine
authors.initials: MA
authors.lastname: May
authors.affiliation: Department of Cardiac Surgery, Tours University Hospital, France.
authors.forename: Rym
authors.initials: R
authors.lastname: El-Khoury
authors.affiliation: Department of Cardiac Surgery, Tours University Hospital, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Marchand
authors.affiliation: Department of Cardiac Surgery, Tours University Hospital, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Aupart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult