AN ANALYSIS OF VALVE RE-REPLACEMENT AFTER AORTIC-VALVE REPLACEMENT WITH BIOLOGIC DEVICES

Biologic valve re-replacement was examined in a series of 1343 patient s who underwent aortic valve replacement at The Prince Charles Hospita l, Brisbane, with a cryopreserved or 4 degrees C stored allograft valv e or a xenograft valve, A parametric model approach was used to simult aneously model the competing risks of death without re-replacement and re-replacement before death, One hundred eleven patients underwent a first re-replacement for a variety of reasons (69 patients with xenogr aft valves, 28 patients with 4 degrees C stored allograft valves, and 14 patients with cryopreserved allograft valves), By multivariable ana lysis younger age at operation was associated with xenograft, 4 degree s C stored allograft, and cryopreserved allograft valve re-replacement , However, this effect was examined in the context of longer survival of younger patients, which increases their exposure to the risk of re- replacement as compared with that in older patients whose decreased su rvival reduced their probability of requiring valve re-replacement, In patients older than 60 years at the time of aortic valve replacement, the probability of re-replacement (for any reason) before death was s imilar for xenografts and cryopreserved allograft valves but higher fo r 4 degrees C stored valves, However, in patients younger than 60 year s, the probability of re-replacement at any time during the remainder of the life of the patient was lower with the cryopreserved allograft valve compared with the xenograft valve and 4 degrees C stored allogra fts.