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The Annals of Thoracic Surgery, Vol 49, 370-383, Copyright © 1990 by The Society of Thoracic Surgeons
EL Jones, WS Weintraub, JM Craver, RA Guyton, CL Cohen, VE Corrigan and CR Hatcher Jr
The porcine bioprosthetic valve was used in 440 patients having isolated
mitral valve replacement (MVR), 522 patients having isolated aortic valve
replacement (AVR), and 88 patients having MVR + AVR between 1974 and 1981.
Patients with associated surgical procedures were excluded. Mean follow-up
was 8.3 years. At 10 years, there was no difference in patient survival
between those having AVR and those having MVR. Reoperations were performed
on 192 patients. Endocarditis was the reason for reoperation in 3.7% of
patients who had MVR and 10.6% of those who had AVR. Structural valve
degeneration was the reason for reoperation in 89.7% of MVR patients and
78.8% of AVR patients (p = 0.04). Hospital mortality among patients having
valve reoperations was 4.7%. At 10 years, the freedom from valve
reoperation for all causes and from structural valve degeneration was
significantly better for the AVR group than the MVR group (74% +/- 3%
versus 61% +/- 4%, p = 0.004; and 79% +/- 3% versus 63% +/- 4%, p = 0.0006,
respectively). For patients in their 60s, the 10-year freedom from
reoperation was 92% +/- 2% for AVR and 80% +/- 6% for MVR (p = not
significant). At 10 years, freedom from cardiac-related death and valve
reoperation was best for both MVR and AVR patients in their 60s. Patients
70 years old or older rarely had reoperation but died before valve failure
occurred. The 10-year freedom from all major valve- related events
(cardiac-related death, reoperation, thromboembolism, endocarditis, and
anticoagulant-related bleeding) was practically the same for both MVR and
AVR patients (48% +/- 3% versus 49% +/- 3%, respectively). The porcine
bioprosthetic valve is the valve of choice only for patients 60 years old
or older. Patients in their 70s have an extremely low rate of reoperation
but a high rate of cardiac-related death and do not outlive the prostheses.
ARTICLES
Ten-year experience with the porcine bioprosthetic valve: interrelationship of valve survival and patient survival in 1,050 valve replacements
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
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