LONG-TERM RESULTS OF HEART-VALVE REPLACEMENT WITH BILEAFLET PROSTHESES

Bileaflet cardiac prostheses (St. Jude, CarboMedics, Duromedics, Bicar bon, Jyros) have shown a low incidence of complications and good haemo dynamic performance. In the last twelve years, 783 bileaflet prosthese s were implanted in 690 patients at our Institution. The population of our study comprises 591 bileaflet prostheses (418 CarboMedics, 124 St . Jude, 49 Bicarbon) implanted in the mitral (MVR) (n=305) or aortic ( AVR), (n=286) position. The follow-up study evaluated 292 male and 295 female patients with age ranging from 13 and 79 years (mean 50.4+/-14 .7 years). Hospital mortality was 6.6%. Follow-up was 97% complete, wi th 1822+/-33 patient/years and a mean follow-up of 37 months (range 1 to 144 months). Twelve years actuarial freedom from complication accor ding to prosthetic site were calculated as follows (linearized rates i n parentheses): late mortality AVR 97.6%+/-0.6% (2.3%), MVR 96%+/-0.5% (2.1%); thrombosis AVR 100%, MVR 96%+/-0.9% (0.8%); embolism AVR 97%/-0.5% (1.5%), MVR 96.6%+/-0.7% (1.8%). Global freedom from anticoagul ant-related haemorrhage was 95%+/-1.2% (2.3%) and 94.5%+/-0.7% (2.2%) following AVR, 94+/-0.6% (2.1%) following MVR. The difference of the h aemorrhagic risk for prosthetic site was not significant (p>0.05). Fun ctional improvement was confirmed by the low postoperative NYHA functi onal class. According to our results, cumulative experience with bilea flet valves has shown very good long-term results in term of low rate of complication, long-term survival and quality of Life.