Structural deterioration in Carpentier-Edwards standard and supraannular porcine bioprostheses,

The Carpentier-Edwards standard (CE-S) porcine bioprosthesis was implanted in 1214 operations (1975 to 1985) and the Carpentier-Edwards supraannular (CESAV) bioprosthesis was implanted in 2,489 operations (1982 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 patient-year and 4.9% per patient-year, respectively. The cumulative follow-up was 9,968 patient-years for the CE-S group and 12,784 patientyears 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 received 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 to 89 years) in those receiving a CE-SAV. The CE-S group consisted of 578 atrial valve replacements (AVRs), 512 mitral valve replacements (MVRs), and 115 multiple valve replacements (MRs). The CE-SAV group consisted of 1,335 AVRs, 938 MVRs, and 200 MRs. There was a total of 165 cases 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 also considered: 20 of the 931 trimmed prostheses used for MVRs and MRs and none of the 207 reduced-trimmed prostheses exhibited SVD. The cumulative follow-up was 5,422 years for the patients with trimmed prostheses and 470 for those with reduced-trimmed prostheses. The freedom from SVD for the AVRs was 90.3% ± 1.9% for the patients with CE-SAVs and 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 dehiscence for CE-SAV MVRs) (p= not significant), but trends were revealed at 10 years (CE-S, CE-SAV, and CE-SAV without SVD, respectively): for 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 years 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 structural valve deterioration than the CE-S when stent dehiscence cases are not considered in the comparison. We consider the cause of stent dehiscence identified and corrected.