Carpentier-Edwards supra-annular aortic porcine bioprosthesis: Clinical performance over 20 years

Abstract

The Carpentier-Edwards supra-annular aortic porcine bioprosthesis continues to provide excellent freedom from structural valve deterioration and overall freedom from valve-related residual morbidity, mortality, and reoperation up to 18 years. Hemodynamic performance is satisfactory. The prosthesis remains recommended for patients older than 70 years and for patients 61 to 70 years of age, especially when comorbid risk factors are not anticipated to provide extended survival.

Twenty-Seven-Year Experience With the St. Jude Medical Biocor Bioprosthesis in the Aortic Position

“…After AVR with the Medtronic Hancock II porcine bioprosthesis, overall survival at 15 and 20 years was reported by David and colleagues [20] to be 37.4% and 19.2%, respectively [20]. Jamieson and associates [21] described an overall survival of 28.8% and 6.8% at 15 and 20 years, respectively, after AVR with the Carpentier-Edwards porcine valve [21]. Forcillo and colleagues [22] recently published data for the Carpentier-Edwards pericardial valve with an overall actuarial survival of 55%, 34% and 16% after 10, 15, and 20 years, respectively.…”

“…To date, long-term data (20 to 25 years) are available for the SJM Biocor prosthesis (Myk en and associates [19], 20 years, 1,712 patients), for the Medtronic Hancock II prosthesis (David and associates [20], 25 years, 1,134 patients), for the Carpentier-Edwards porcine valve (Jamieson and associates [21], 20 years, 1,823 patients), for the Carpentier-Edwards pericardial valve (Forcillo and associates [22], 25 years, 2,405 patients), and for the Sorin Mitroflow prosthesis (Yankah and associates [23], 21 years, 1,513 patients). However, outcomes from studies after implantation of different prosthetic heart valves, or even the same brand of prosthetic heart valves, have limited comparability because patients' baseline characteristics (cardiac and noncardiac) and the indications for valve replacement may differ [17].…”

Very Long-Term Outcomes of the Carpentier-Edwards Perimount Valve in Aortic Position

“…In a study comparing modified Mitroflow (Sorin; Milan, Italy) and CE Perimount, Houel and colleagues [30] report an actuarial freedom from SVD at 10 and 15 years of 56% AE 4% and 5% AE 4%, respectively for the Mitroflow, compared with 87% AE 4% and 63% AE 8% for the Perimount [30]. The CE Perimount also compares favorably with second-generation porcine valves (Hancock II, CE-SAV, Medtronic Intact; Medtronic, Minneapolis, MN), which present actuarial survival rates without SVD at 10, 15, and 20 years between 94% and 98%, 75% and 92%, and 49% and 70%, respectively [17,18,[31][32][33][34]. This improvement in durability may be due to decreased stress-induced structural deterioration through infra-stent tissue mounting, better tissue orientation, and improved tissue preservation techniques.…”

Influence of Prosthesis-Patient Mismatch on Survival with Aortic Valve Replacement

“…More specifically, 667 patients had CarpentierEdwards PERIMOUNT pericardial prostheses (Edwards Lifesciences, Irvine, CA), 1250 patients had Carpentier-Edwards supra-annular porcine prostheses, 576 patients had Medtronic Mosaic porcine prostheses (Medtronic, Minneapolis, MN), 462 patients had St. Jude Medical mechanical prostheses (St. Jude Medical, St. Paul, MN), and 388 patients had CarboMedics mechanical prostheses (Sorin-CarboMedics, Saluggia, Italy) ( Figure 1). There is a misconception with the Carpentier-Edwards supra-annular aortic valve for the early version (prior to 1985) of the mitral valve failed because of stent-post dehiscence due to excessive trimming of the aortic wall; however, this failure mode was identified in only one aortic prosthesis before the manufacturing trimming was changed (Jamieson et al, 2005;Jamieson et al, 2009). The level of PPM was classified for each patient based on reference EOAs and size for each prosthesis in the published literature.…”