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(Circulation. 1999;100:II-11.)
© 1999 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Mid-Term Comparative Follow-Up After Aortic Valve Replacement with Carpentier-Edwards and Pericarbon Pericardial Prostheses

Thierry Le Tourneau, MD; Christine Savoye, MD; Eugene P. McFadden, FRCPI; Daniel Grandmougin, MD; Hubert-François Carton, MD; Jean-Luc Hennequin, MD; Arnaud Dubar, MD; Georges Fayad, MD; Henri Warembourg, MD

From the Service de Chirurgie Cardio-Vasculaire B (T.L.T., E.P.M., D.G., H.-F.C., J.-L.H., A.D., G.F., H.W.), Hôpital Cardiologique, and the Service d’Exploration Fonctionnelle Cardio-Vasculaire (C.S.), Hôpital Cardiologique, Centre Hospitalier Régional et Universitaire de Lille, Lille, France.

Correspondence to Dr T. Le Tourneau, Service de Chirurgie Cardio-Vasculaire B, Hôpital Cardiologique, Boulevard du Professeur J. Leclercq, 59037 Lille Cedex, France. E-mail goleklunder{at}chru.lille.fr

Background—The first generation of pericardial valves had a high rate of premature deterioration. The aim of this study was to compare the outcome after aortic valve replacement with second generation pericardial prostheses (Pericarbon and Carpentier-Edwards).

Methods and Results—Between 1987 and 1994, 162 patients underwent aortic valve replacement with either a Pericarbon (n=81, 69±11 years) or a Carpentier-Edwards (n=81, 70±11 years) pericardial prosthesis. Mean follow-up was 4.4±2.7 years for Pericarbon and 4.8±2.4 years for Carpentier-Edwards valves (P=0.27), giving a total follow-up of 745 patient-years. Thirty-day mortality and 5-year actuarial survival were, respectively, 6.2% and 63.2±5.7% in the Pericarbon group and 6.2% and 63.5±5.6% in the Carpentier-Edwards group. At 8 years, freedom from (and linearized rates per patient-year) thromboembolism, structural failure, and all valve-related events were, respectively, 91.8±3.6% (1.4%), 76.9±8.7% (2.5%), and 58.4±9.3% (5.6%) in the Pericarbon group and 94.4±2.7% (1%), 100% (0%, P<0.01), and 88.8±3.7% (2%, P<0.05) in the Carpentier-Edwards group. There were 9 (11.1%) Pericarbon structural failures related predominantly to severe calcification and stenosis. The actual reoperation rate was 7.4% (1.6% per patient-year) in the Pericarbon group for fibrocalcific degeneration (n=3), periprosthetic leak (n=1), endocarditis (n=1), and aortic dissection (n=1). There was neither structural valve failure nor valve reoperation in the Carpentier-Edwards group. Echocardiographic review of 70 patients from 85 survivors (82.3%) found 4 additional Pericarbon valves with signs of early structural failure but no Carpentier-Edwards valve with such changes.

Conclusions—Eight years after aortic valve replacement, Pericarbon pericardial prostheses compared unfavorably with Carpentier-Edwards pericardial prostheses, with a high incidence of structural valve failure and reoperation.

Key Words: valves • surgery • prosthesis • complications