Abstract 12304: Long-term Results of CarboMedics Mechanical Heart Valves: A Single Institutional Follow-up of 784 Prosthetic Valves Used for Both Primary and Re-operations for Recent 22 Years
Background: Long-term results over 20 years of CarboMedics mechanical heart valves used for both primary and re-operation have never been reported and compared.
Method: A total of 784 CarboMedics valves have been implanted in 691 patients for aortic valve replacement (AVR) in 222 patients (55±14 years old), for mitral valve replacement (MVR) in 376 patents (60±11), and for double (aortic and mitral) valve replacement (DVR) in 93 patients (56±14) at our institution since 1990. Re-do valve replacement have been performed in 19 patients (8.6%) of the AVR group, in 108 patients (29%) of the MVR group, and in 15 patients (16%) of the DVR group. Follow-up was completed in 98.5 % with 7145 patient-year.
Results: Hospital mortality in the AVR, MVR and DVR groups was 0.9, 3.7 and 4.3%, respectively. Actuarial survival rate in each group was 74.7, 69.7 and 76.0% at 10 years, and 53.4, 40.0 and 51.2% at 20 years. Freedom from valve related death was 91.2, 89.1 and 93.5% at 10 years, and 83.4, 72.8 and 82.9% at 20 years, respectively (p=0.5581). Structural valve deterioration was never observed in any of the groups. Freedom from valve-related morbidity in the AVR, MVR and DVR groups was 80.2, 75.7 and 76.2% at 10 years, and 70.3, 47.0 and 51.8% at 20 years (P=0.0206), suggesting a better result in the AVR group than those in other groups. Occurrence of bleeding events, thromboembolism, and valve thrombosis was similar among the three groups. Freedom from non-structural dysfunction in the AVR (including 6 para-valvular leakage (PVL)), MVR (1 pannus formation and 31 PVL) and DVR (10 mitral PVL) groups, however, was 98.6, 92.9 and 94.4% at 10 years, and 97.0, 79.8 and 78.2% at 20 years, respectively (P=0.0004). Ninety seven percent of the mitral PVL after the single MVR was observed in the re-do single MVR, while 70 % of the mitral PVL after DVR was observed in the DVR including re-do MVR. Only 1 case of mitral PVL was observed among the 268 patients with primary MVR.
Conclusions: The use of CarboMedics mechanical valves resulted in the excellent hospital mortality, actuarial survival, and freedom from valve-related morbidity and death in all groups even 20 years after the surgery. Care should be taken, however, especially for preventing PVL in the mitral position during the re-operation.
- © 2012 by American Heart Association, Inc.