Very Long-Term Outcomes of the Carpentier-Edwards Perimount Aortic Valve in Patients Aged 60 or Younger

Background. Aortic valve replacement using a bioprosthesis remains controversial for patients younger than 60 years because of missing data on long-term outcomes in this age group. Methods. From 1984 to 2008, 383 Carpentier-Edwards Perimount pericardial aortic bioprostheses were implanted in 373 patients 60 years or younger (mean age, 51.0 +/- 9.2 years; 19% female). Multiple valve replacements were excluded from our cohort. Baseline clinical, perioperative, and follow-up data were recorded prospectively. The mean follow-up was 8.6 +/- 5.9 years, for a total of 3,299 valve-years. Follow-up was complete for 95.3% of patients included. Results. Operative mortality rate was 1.3%. Eighty-five late deaths occurred, for a linearized rate of 2.6%/valveyear. Actuarial survival rates averaged 78.1% +/- 2.6%, 65.6% +/- 3.5%, and 46.8% +/- 6.0% after 10, 15, and 20 years of follow-up, respectively. Mortality rate associated with reoperation was 2.3%. Actuarial freedom from reoperation rates attributable to structural valve deterioration at 10, 15, and 20 years were, respectively, 88.3% +/- 2.4%, 70.8% +/- 4.1%, and 38.1% +/- 5.6%. Competing risk analysis demonstrated an actual risk of explantation secondary to structural valve deterioration at 20 years of 41.6% +/- 4.1%. Expected valve durability was 17.6 years for this age group. Conclusions. In selected patients 60 years or younger undergoing aortic valve replacement with the Carpentier-Edwards Perimount bioprosthesis, the expected valve durability was 17.6 years. Reoperation for structural valve deterioration was associated with a low risk of mortality. (C) 2015 by The Society of Thoracic Surgeons