Structural valve deterioration in mitral replacement surgery: Comparison of carpentier-edwards supra-annular porcine and perimount pericardial bioprostheses

Abstract

Background: Bioprostheses preserved with glutaraldehyde, both porcine and pericardial, have been available as second-generation prostheses for valve replacement surgery. The performance with regard to structural valve deterioration with the Carpentier-Edwards supra-annular (CE-SAV) porcine bioprosthesis and the Carpentier-Edwards Perimount (CE-P) pericardial bioprosthesis (Baxter Healthcare Corp, Edwards Division, Santa Ana, Calif) was evaluated to determine whether there was a difference in mitral valve replacement. Methods: The CE-SAV bioprosthesis was implanted in 1266 overall mitral valve replacements (isolated mitral, 1066; mitral in multiple, 200) and the CE-P bioprosthesis in 429 overall mitral valve replacements (isolated mitral, 328; mitral in multiple, 101). The mean age of the CE-SAV population was 64.2 ± 12.2 years and that of the CE-P population, 60.7 ± 11.7 years (P = .0001). For the study, structural valve deterioration was diagnosed at reoperation for explantation. Results: The freedom from structural valve deterioration was evaluated to 10 years, and the freedom rates reported are at 10 years. For the overall mitral valve replacement groups, the actuarial freedom from deterioration was significant (P = .0001): CE-P > CE-SAV for 40 years or younger, 80% versus 60%; 41 to 50 years, 91% versus 61%; 51 to 60 years, 84% versus 69%; 61 to 70 years, 95% versus 75%. The older than 70-year group was 100% versus 92% (no significant difference). The actual freedom from structural valve deterioration also demonstrated the same pattern at 10 years: 40 years or younger, CE-P 82% versus CE-SAV 68%; 41 to 50 years, 92% versus 70%; 51 to 60 years, 90% versus 80%; 61 to 70 years, 97% versus 88%; and older than 70 years, 100% versus 97%. The independent risk factors of structural valve deterioration for the overall mitral valve replacement group were age and age groups and prosthesis type (CE-SAV > CE-P). The prosthesis type either in isolated replacement or in multiple replacement was not predictive of structural valve deterioration. The pathology of structural valve deterioration was different: 70% of CE-P failures were due to calcification and 57% of CE-SAV failures were due to combined calcification and leaflet tear.

Mitral valve disease: if the mitral valve is not reparable/failed repair, is bioprosthesis suitable for replacement?☆

“…The last report on the CE-SAV MVR was in 1999 when Jamieson and international colleagues [7] compared the Vancouver CE-SAV MVR experience to the worldwide experience with the CE-PERIMOUNT MVR. The durability, at 10 years, was different with freedom from SVD diagnosed at reoperation being in favor of CE-P for age groups 51-60, 61-70 and >70 years, as documented in Table 4.…”

“…In 1999, from a multi-center study, Jamieson et al [7] reported on structural valve deterioration (SVD), diagnosed at reoperation, between the CE-PERIMOUNT (CE-P) mitral pericardial bioprosthesis and the CE-SAV mitral porcine bioprosthesis. This study identified an inherent superiority of the CE-P but the failure modes of the two bioprostheses, necessitating intervention, were not taken into consideration; predominantly calcific stenosis of the CE-P and regurgitant failure of the CE-SAV.…”

Bioprosthetic Heart Valves: Impact of Implantation on Biomaterials

“…reported freedom from SVD at 5, 10, and 15 years to be 99%, 94%, and 77%, respectively. Jamieson et al [50] reported that 10 years after-implantation, the incidence of SVD was more in CE porcine valve (CE-SAV) as compared to the CEP valve, which could be due to low commissural region stress in CEP valve. Butany et al have reported that the incidence of SVD was much higher in ISLP valves (71% at, 2-5 years after implantation) and in Hancock II porcine valves (56% at, 5.1 years post implant) [28,51] as compared to the CEP valves.…”

Performance of Bovine Pericardial Valves in the Pulmonary Position

“…Mechanical valves lead to a persistent need for anticoagulation therapy, and despite some positive reports in the literature, have generally been associated with pulmonary thromboembolic complications [10, 11]. In our institution we have utilized bovine pericardial valves for pulmonary valve replacement because of the superior long-term outcomes of these valves in the aortic and mitral positions and because of the promising early results with their use in the pulmonary position [12, 13, 14]. …”