The Carpentier-Edwards Standard Porcine Bioprosthesis: Clinical Performance to 15 Years

Abstract

The Carpentier‐Edwards standard porcine bioprosthesis was implanted in 1,195 patients in 1,213 operative procedures between 1975 and 1987, with the majority of implants performed prior to 1982 at the University of British Columbia. The mean age of the patient population was 57.2 years (range 8 to 85 years). The mean follow‐up was 7.4 years per patient. The freedom from the combination of thromboemboiism and antithromboembolic therapy‐related hemorrhage at 15 years was 79.5% for aortic valve replacement (AVR), 72% for mitral valve replacement (MVR), and 84% for multiple valve replacement (MR) (p < 0.05, AVR > MR > MVR). The freedom from structural valve deterioration at 15 years was 71% for AVR, 41% for MVR, and 41% for MR (14 years) (p < 0.05, AVR > MVR > MR). The freedom from nonstructural dysfunction and prosthetic valve endocarditis did not distinguish the valve positions (p = NS). The freedom from valve‐related mortality from all causes including reoperation was 92% for AVR, 78% for MVR, and 77% for MR at 15 years (p < 0.05, AVR > MVR > MR). The freedom from residual morbidity was not significantly different between valve positions (p = NS). The freedom from treatment failure (valve‐related mortality and residual morbidity) at 15 years was 87% for AVR, 72% for MVR, and 75% for MR (p < 0.05, AVR > MR > MVR). The freedom from all complications at 14 years was 50% for AVR, 25% for MVR, and 27% for MR (p < 0.05, AVR > MR > MVR). The Carpentier‐Edwards standard porcine bloprosthesis has provided satisfactory clinical performance in a valve replacement population essentially receiving only biological prostheses.

Update on Cardiac Valve Surgery

“…In 1995, Jamieson confirmed previous durability reports by demonstrating that 86% of Carpentier-Edwards valves used for aortic replacement and 70% of those used for mitral replacement were free of structural deterioration at 10 years. However, these values decreased to 58% and 21% at 15 years, and to 39% and 14% at 17 years for the aortic and mitral prostheses, respectively (11)(12)(13). These freedom values are similar to the 18-year freedom from structural valve deterioration (at a younger mean age) reported for the Hancock prosthesis by Bortolotti and associates (14).…”

Textura de bioprótese mitral, função ventricular esquerda e formação de trombo: análise por ecocardiografia transesofágica e aplicação de bioescore

“…The mitral position of bioprosthesis favors the earlier primary degeneration of leaflets, probably because of a greater closing stress, which takes place in mitral position during the systole 27,[38][39][40] . In mitral position, the opening time of leaflets is up to three times the opening time of aortic bioprosthesis leaflets 41 .…”

Stented Porcine and Pericardial Bioprostheses - A historical review

“…The initial results were extremely gratifying reporting a low incidence of reoperations for SVD and thromboembolic complications at a mediumterm follow-up further supporting the initial enthusiasm 20 . Subsequently, other companies started to manufacture different models of porcine bioprostheses; some of them were abandoned quite early while others demonstrated good reliability and were implanted until the more recent years 21,22 . Some early problems encountered with porcine bioprostheses were related to the excessive height of the stent which caused fatal left ventricular outflow tract obstruction and left ventricular rupture when used for MVR 23,24 .…”