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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2003 December;44(6):691-699

lingua: Inglese

Twenty-year follow-up of the Carpentier-Edwards standard porcine bioprosthesis in the Oriental population

Chen Y. F., Lee C. S., Lin C. C., Su S. F., Chen M. L., Hsieh C. C., Chen H. M., Chiu C. C., Lu Y. H., Liang H. Y., Yen H. W., Hwang Y. S., Lin Y. T.

Divi­sion of Car­di­o­vas­cular Sur­gery and Car­di­ology Kaoh­siung Med­ical Uni­ver­sity Hos­pital, Kaoh­siung, ­Taiwan

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Aim. The 20-­year ­period ­long-­term ­results of por­cine bio­pros­thetic ­valve use are lim­ited. In addi­tion, the ­majority of ­these ­reports ­come ­from ­Western coun­tries. ­Given the ­scanty infor­ma­tion ­reported in ­Oriental coun­tries, ­this ­study was there­fore ­designed to ­examine 20-­year ­long-­term ­results in ­patients who ­received a Car­pentier-­Edwards por­cine bio­pros­thetic ­valve in an ­effort to con­tribute fur­ther infor­ma­tion on the ­long-­term clin­ical per­for­mance of por­cine pros­thetic ­valves ­from a view­point of ­results in the ­Oriental pop­u­la­tion.
­Methods. ­From ­July 1979 to ­April 2001, 82 ­patients ­received ­valve replace­ment ­with a stan­dard Car­pentier-­Edwards por­cine ­valve. ­There ­were 40 men and 42 ­women ­with a ­mean age of 42.3±15.1 ­years (­range 16 to 73 ­years). ­Follow-up ­time ­extended ­more ­than 20 ­years (­mean 10.9±3.2 ­years, ­range 0.5 to 21.5 ­years ) for a ­total of 719.5 ­patient-­years.
­Results. The ­overall oper­a­tive mor­tality was 16.9% (14 of 83 pro­ce­dures). At 5, 10, 15, and 20 ­years, the actu­arial sur­vival ­rate of ­patients was 71.7%, 66.9%, 55.5%, and 44.4%, respec­tively. Actu­arial esti­mates of ­freedom ­from struc­tural val­vular dete­ri­ora­tion (SVD) at 5, 10, 15, and 17 ­years ­were 96.3%, 64.0%, 24.3%, and 24.3%, respec­tively; ­from reop­er­a­tion 96.3%, 64.5%, 24.5%, and 24.5%; ­from oper­ated val­vular endo­car­ditis 96.8%, 92.6%, 92.6%, and 92.6%; and ­from ­overall throm­boem­bo­lism 96.3%, 88.5%, 67.2%, and 52.2%. In ­normal ­sinus ­rhythm, actu­arial esti­mates of ­freedom ­from throm­boem­bo­lism at 5, 10, 15, and 17 ­years ­were 100.0%, 100.0%, 81.8%, and 81.8%, respec­tively. ­Whereas for ­those in ­patients ­with ­atrial fib­ril­la­tion, the esti­mates of ­freedom ­from throm­boem­bo­lism ­were 94.5%, 82.4%, 57.7%, and 38.5%.
Con­clu­sion. ­This ­study dem­on­strates the ­very sat­is­fac­tory 20-­year ­period ­long-­term per­for­mance of ­freedom ­from ­bleeding ­events, throm­boem­bo­lism (­except in ­patients ­with ­atrial fib­ril­la­tion), and val­vular endo­car­ditis in ­Oriental ­patients under­going replace­ment ­with a por­cine ­valve. How­ever, the remark­able ­rate of SVD and reop­er­a­tion ­ensued at 6 ­years ­after bio­pros­thesis ­implanted ­which ­does not ­differ ­from the ­series ­reported ­from ­Western coun­tries.

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