Very Long-Term Outcomes of the Carpentier-Edwards Perimount Valve in Aortic Position

Background. The Carpentier-Edwards Perimount pericardial bioprosthesis (Edwards Lifesciences, Irvine, CA) has demonstrated good long-term outcomes, but its durability remains unclear depending on age at implantation. We report our 20-year experience with the Perimount valve implanted in the aortic position, with particular attention to the probability and time to reoperation required due to bioprosthesis deterioration. Methods. From 1984 to 2008 at our center, 2,659 patients (mean age, 70.7 +/- 10.4 years) underwent aortic valve replacement using the Perimount pericardial bioprostheses. Patients were prospectively followed on an annual basis (mean 6.7 +/- 4.8 years, range 0 to 24.6 years) with an echocardiogram at the time of follow-up. Cumulative follow-up was 18,404 valve-years. Bioprosthesis structural valve deterioration was determined by strict echocardiographic assessment. Results. Overall operative mortality was 2.8%. Actuarial survival rates including early deaths averaged 52.4% +/- 1.2%, 31.1% +/- 1.4%, and 14.4% +/- 1.7% after 10, 15, and 20 years of follow-up, respectively. Age-stratified freedom from reoperation due to structural valve deterioration at 15 and 20 years was 70.8% +/- 4.1% and 38.1% +/- 5.6%, respectively, for the group aged 60 years or less, 82.7% +/- 2.9% and 59.6% +/- 7.6% for those 60 to 70 years, and 98.1% +/- 0.8% at 15 years and above for the oldest group. Expected valve durability is 19.7 years for the entire cohort. Conclusions. With a low rate of valve-related events at 20 years, and particularly a low rate of structural valve deterioration, the Carpentier-Edwards Perimount pericardial bioprosthesis remains a reliable choice for a tissue valve in the aortic position, especially in patients over 60 years of age. (C) 2015 by The Society of Thoracic Surgeons