STRUCTURAL DETERIORATION IN CARPENTIER-EDWARDS STANDARD AND SUPRAANNULAR PORCINE BIOPROSTHESES

The Carpentier-Edwards standard (CE-S) porcine bioprosthesis was impla nted in 1214 operations (1975 to 1985) and the Carpentier-Edwards supr aannular (CE-SAV) bioprosthesis was implanted in 2,489 operations (198 2 to 1992 inclusive). The early mortality was 7.6% and 7.4% for the CE -S and CE-SAV groups, respectively; the late mortality was 5.3% per pa tient-year and 4.9% per patient-year, respectively. The cumulative fol low-up was 9,968 patient-years for the CE-S group and 12,784 patient-y ears for the CE-SAV group. Concomitant procedures were performed in 26 .8% of the patients who received a CE-S and in 40.9% of those who rece ived a CE-SAV (p < 0.05). The mean age of the patients receiving a CE- S was 57.3 years (range, 8 to 85 years) and was 64.1 years (range, 6 t o 89 years) in those receiving a CE-SAV. The CE-S group consisted of 5 78 atrial valve replacements (AVRs), 512 mitral valve replacements (MV Rs), and 115 multiple valve replacements (MRs). The CE-SAV group consi sted of 1,335 AVRs, 938 MVRs, and 200 MRs. There was a total of 165 ca ses of structural valve deterioration (SDV) in the CE-SAV group (AVR, 35; MVR, 98; and MR, 32). The effect of trimming the aortic wall was a lso considered: 20 of the 931 trimmed prostheses used for MVRs and MRs and none of the 207 reduced-trimmed prostheses exhibited SVD. The cum ulative follow-up was 5,422 years for the patients with trimmed prosth eses and 470 for those with reduced-trimmed prostheses. The freedom fr om SVD for the AVRs was 90.3% +/- 1.9% for the patients with CE-SAVs a nd 85.5% +/- 1.8% for those with CE-Ss (p < 0.05) (age as a covariate, p = not significant). The freedom from SVD at 10 years did not differ between the CE-SAV and CE-S groups (including and excluding stent deh iscence for CE-SAV MVRs) (p = not significant), but trends were reveal ed at 10 years (CE-S, CE-SAV, and CE-SAV without SVD, respectively): f or patients aged 36 to 50 years it was 64.1% +/- 5.5%, 67.8% +/- 7.1%, and 70.8% +/- 6.8%; for those aged 51 to 64 years it was 73.0% +/- 3. 9%, 72.1% +/- 4.4%, and 76.9% +/- 4.2%; and for those aged 65 to 69 ye ars it was 66.6% +/- 7.5%, 74.0% +/- 6.3%, and 79.3% +/- 5.9%. The CE- SAV porcine bioprosthesis appears to have a greater freedom from struc tural valve deterioration than the CE-S when stent dehiscence cases ar e not considered in the comparison. We consider the cause of stent deh iscence identified and corrected.