title: Very long-term outcomes of the Carpentier-Edwards Perimount aortic valve in patients aged 50-65 years.
abstract: OBJECTIVE
  Aortic valve replacement (AVR) using a bioprosthesis remains controversial for patients aged 50-65 years. This cohort study reports the very long-term outcomes of AVR using Carpentier-Edwards Perimount pericardial bioprosthesis in this age group.
  
  
  METHODS
  From 1984 to 2008, 522 Carpentier-Edwards Perimount pericardial aortic bioprostheses were implanted in 516 patients aged 50-65 years (mean age, 60 ± 4 years; 19% female). Multiple valve replacements were excluded fro m our cohort. Baseline demographic, perioperative and follow-up data were recorded prospectively. Mean follow-up was 9 ± 6 years, for a total of 4428 valve-years. Follow-up was complete for 97% of patients included.
  
  
  RESULTS
  Operative mortality rate was 2%. One hundred and forty-six late deaths occurred for a linearized rate of 3%/valve-year. Actuarial survival rates averaged 73 ± 2, 59 ± 3 and 35 ± 5% after 10, 15 and 20 years of follow-up, respectively. Mortality rate associated with reoperation was 2%. Actuarial freedom from reoperation rates due to structural valve deterioration (SVD) at 10, 15 and 20 years was respectively of 91 ± 2, 76 ± 3 and 50 ± 6%. Competing risk analysis demonstrated an actual risk of explantation secondary to SVD at 20 years of 30 ± 3%. Expected valve durability was 19 years for this age group. Age was not a significant risk factor for SVD in this middle-aged population.
  
  
  CONCLUSIONS
  In patients aged 50-65 years undergoing AVR with the Carpentier-Edwards Perimount bioprosthesis, the expected valve durability was 19 years. Age was not a significant risk factor for SVD within this age group. Patient selection and attention to timing of reintervention may be determinants of long-term outcomes.
authors.affiliation: Department of Cardiac Surgery, Tours University Hospital, Tours, France thierry-bourguignon@hotmail.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Bourguignon
authors.affiliation: Department of Cardiac Surgery, Tours University Hospital, Tours, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lhommet
authors.affiliation: Department of Cardiac Surgery, Tours University Hospital, Tours, 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, Tours, France.
authors.forename: Claudia
authors.initials: C
authors.lastname: Loardi
authors.affiliation: Department of Cardiac Surgery, Tours University Hospital, Tours, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Mirza
authors.affiliation: Department of Cardiac Surgery, Tours University Hospital, Tours, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Boulanger-Lothion
authors.affiliation: Department of Cardiac Surgery, Tours University Hospital, Tours, France.
authors.forename: Anne-Lorraine
authors.initials: AL
authors.lastname: Bouquiaux-Stablo-Duncan
authors.affiliation: Department of Cardiac Surgery, Tours University Hospital, Tours, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Marchand
authors.affiliation: Department of Cardiac Surgery, Tours University Hospital, Tours, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Aupart
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Bioprosthesis; Complications; Heart valve; Statistics; Surgery; Survival analysis