Age and valve size effect on the long-term durability of the Carpentier-Edwards aortic pericardial bioprosthesis

Background. Bioprosthesis durability decreases with time and younger age. H owever, the time-scale and determinants of durability of the aortic Carpent ier-Edwards stented bovine pericardial prosthesis are incompletely characte rized. Methods. Between September 1981 and January 1984, 267 patients underwent im plantation of the pericardial aortic prosthesis at four centers. Mean age a t implant was 65 +/- 12 years (range 21 to 86 years). Follow-up averaged 12 +/- 4.5 years. The primary end point was explant for structural valve dysf unction (SVD), which was analyzed multivariably in the context of death as a competing risk. Results. Freedom from explant due to SVD was 99%, 94%, and 77% at 5, 10, an d 15 years. Risk of SVD increased exponentially with time and younger age ( p = 0.0001) at implantation; an increased risk of small valve size was not reliably demonstrated (p = 0.1). Considering the competing risk of death, p atients aged 65 years or older had a less than 10% chance of explant for SV D by 15 years. Conclusions. Durability of this stented pericardial aortic bioprosthesis is excellent and justifies its use in patients aged 65 or older. (C) 2001 by The Society of Thoracic Surgeons.