title: Long-term durability of pericardial valves in the aortic position in younger patients: when does reoperation become necessary?
abstract: BACKGROUND
  We sought to assess the long-term durability of pericardial valves in patients at age <65 years undergoing aortic valve replacement (AVR), and to determine the timing of redo operations due to structural valve deterioration (SVD).
  
  
  METHODS
  From 1986 to 2001, a total of 574 adult patients underwent AVR with pericardial valves in nine hospitals in Japan. Of these, 53 patients were at age <65 years (group Y). These patients were compared with those of age ≥ 65 (group O, n = 521).
  
  
  RESULTS
  The mean follow-up duration was 9.5 years in group Y and 8.1 years in group O. Freedom from reoperation due to SVD was 100% at five years, 90.8% at 10 years, and 47.2% at 15 years in group Y, and 99.3% at five years, 97.4% at 10 years, and 94.4% at 15 years in group O (log-rank test, p < 0.01). In those who required redo AVR in group Y (n = 12), the mean time from initial operation to reoperation was 12.1 years. The reoperation-free survival curve started to decline after eight years postoperation in group Y.
  
  
  CONCLUSIONS
  Redo AVR started to become necessary eight years after surgery in the patients who underwent AVR with pericardial valve at age <65 years. In addition, approximately half of those patients required reoperation due to SVD by 15 years postoperatively.
authors: Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Kenji
authors: K
authors: Minakata
authors: Shiro
authors: S
authors: Tanaka
authors: Yoshiharu
authors: Y
authors: Takahara
authors: Tatsuo
authors: T
authors: Kaneko
authors: Akihiko
authors: A
authors: Usui
authors: Mitsuomi
authors: M
authors: Shimamoto
authors: Yohei
authors: Y
authors: Okawa
authors: Hitoshi
authors: H
authors: Yaku
authors: Kazuo
authors: K
authors: Yamanaka
authors: Nobushige
authors: N
authors: Tamura
authors: Ryuzo
authors: R
authors: Sakata
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors