title: Very Long-Term Outcomes of the Carpentier-Edwards Perimount Aortic Valve in Patients Aged 60 or Younger.
abstract: BACKGROUND
  Aortic valve replacement using a bioprosthesis remains controversial for patients younger than 60 years because of missing data on long-term outcomes in this age group.
  
  
  METHODS
  From 1984 to 2008, 383 Carpentier-Edwards Perimount pericardial aortic bioprostheses were implanted in 373 patients 60 years or younger (mean age, 51.0 ± 9.2 years; 19% female). Multiple valve replacements were excluded from our cohort. Baseline clinical, perioperative, and follow-up data were recorded prospectively. The mean follow-up was 8.6 ± 5.9 years, for a total of 3,299 valve-years. Follow-up was complete for 95.3% of patients included.
  
  
  RESULTS
  Operative mortality rate was 1.3%. Eighty-five late deaths occurred, for a linearized rate of 2.6%/valve-year. Actuarial survival rates averaged 78.1% ± 2.6%, 65.6% ± 3.5%, and 46.8% ± 6.0% after 10, 15, and 20 years of follow-up, respectively. Mortality rate associated with reoperation was 2.3%. Actuarial freedom from reoperation rates attributable to structural valve deterioration at 10, 15, and 20 years were, respectively, 88.3% ± 2.4%, 70.8% ± 4.1%, and 38.1% ± 5.6%. Competing risk analysis demonstrated an actual risk of explantation secondary to structural valve deterioration at 20 years of 41.6% ± 4.1%. Expected valve durability was 17.6 years for this age group.
  
  
  CONCLUSIONS
  In selected patients 60 years or younger undergoing aortic valve replacement with the Carpentier-Edwards Perimount bioprosthesis, the expected valve durability was 17.6 years. Reoperation for structural valve deterioration was associated with a low risk of mortality.
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: Rym
authors.initials: R
authors.lastname: El Khoury
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: Claudia
authors.initials: C
authors.lastname: Loardi
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: Julie
authors.initials: J
authors.lastname: Boulanger-Lothion
authors.affiliation: Department of Cardiac Surgery, Tours University Hospital, France.
authors.forename: Anne-Lorraine
authors.initials: AL
authors.lastname: Bouquiaux-Stablo-Duncan
authors.affiliation: Department of Cardiac Surgery, Tours University Hospital, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Espitalier
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; D000367:Age Factors; 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; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult