The perimount valve in the aortic position: twenty-year experience with patients under 60 years old

Ann Thorac Surg. 2014 May;97(5):1526-32. doi: 10.1016/j.athoracsur.2014.02.019. Epub 2014 Mar 28.

Abstract

Background: With improved durability of contemporary bioprostheses, surgeons are now recommending biologic valves in younger patients. However, long-term outcomes of patients younger than 60 years old undergoing biologic aortic valve implantation are not well known.

Methods: From November 1991 to March 2011, 144 patients less than 60 years old underwent aortic valve replacement (AVR) with Carpentier-Edwards pericardial valves (Edwards Lifesciences, Irvine, CA). Mean follow-up was 10±4 years. Outcomes were reported according to published guidelines.

Results: Seventy-five percent of patients were male, with a mean age of 51±9 years. Actuarial survival rates including early deaths were 89%±3%, 79%±4%, and 57%±6% after 5, 10, and 15 years of follow-up, respectively. Survival of patients was comparatively lower than a gender- and age-matched general population at all time points. The freedom from major adverse cardiac events (myocardial infarction, heart failure, hemorrhage, thromboembolic event, and endocarditis) was 89%±3%, 87%±3%, and 75%±6% at 5, 10, and 15 years after surgery. The freedom rate from prosthetic valve dysfunction was 97%±2%, 84%±4%, and 57%±6% at 5, 10, and 15 years after surgery. Patients with a diagnosis of structural valve deterioration (29 of 37, 78%) underwent reoperation 11±5 years after the initial valve replacement with no perioperative mortality.

Conclusions: In patients younger than 60 years undergoing AVR, the Carpentier-Edwards Perimount bioprosthesis provided satisfactory clinical outcomes. However, late survival was inferior to an age- and gender-matched population. Structural valve deterioration and the need for reintervention were common late after implantation, but reoperation for prosthetic valve dysfunction was associated with a very low risk of mortality.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / surgery*
  • Bioprosthesis*
  • Cardiopulmonary Bypass / methods
  • Cause of Death*
  • Cohort Studies
  • Echocardiography, Doppler / methods
  • Female
  • Heart Valve Diseases / diagnostic imaging
  • Heart Valve Diseases / mortality
  • Heart Valve Diseases / surgery*
  • Heart Valve Prosthesis
  • Heart Valve Prosthesis Implantation / methods*
  • Heart Valve Prosthesis Implantation / mortality
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Prosthesis Failure
  • Reoperation / methods
  • Retrospective Studies
  • Survival Rate
  • Treatment Outcome
  • Young Adult