Age and valve size effect on the long-term durability of the Carpentier-Edwards aortic pericardial bioprosthesis

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…166 A review of Medicare data, 167 involving 684 US hospitals and more than 142 000 patients, indicates that the average in-hospital mortality for AVR in patients over the age of 65 years is 8.8% (13.0% in lowvolume centers and 6.0% in high-volume centers). In addition, despite improved longevity of current-generation bioprosthetic valves, 168,169 AVR in young patients subjects them to the risks of structural valve deterioration of bioprostheses 168,170 -174 and the appreciable morbidity and mortality of mechanical valves. 172,174 -178 Thus, the combined risk of surgery in older patients and the late complications of a prosthesis in younger patients needs to be balanced against the possibility of preventing sudden death, which, as noted above, occurs at a rate of less than 1.0% per year.…”

“…However, the rate of structural valve deterioration is agerelated, 168,[867][868][869][870][871][872][873][874][875][876][877][878][879][880] being increased for younger patients, and in patients less than 40 years of age, approximately half of porcine valves fail by 10 years (Table 35). Bovine pericardial valves appear to have a lower rate of structural valve deterioration, with 15-year data indicating that 77% of valves in surviving patients of all ages are functioning without 168,876 The reported rate of structural valve deterioration for second-generation porcine valves appears so far to be equivalent to that of stented bovine valves.…”

Tissue Valve Is the Preferred Option for Patients Aged 60 and Older

“…6 SVD for porcine valve after MVR began at ≈5 years, and in AVR ≈8 years. Recent bovine pericardial valve has much longer durability of 12 years or more, [26][27][28][29] which has inspired the enthusiasm for using bioprostheses in young patients. High rate of valve failure in the old 2 RCTs can be attributed to usage of porcine bioprostheses.…”

“…10 In retrospective studies, SVD in young patients (<65) are reported from 11%/12 years 30 to 61%/20 years 31 in AVR and 25%/17 years 32 to 73%/20 years 31 in MVR, certainly less with current pericardial valves. [26][27][28][29] There is no question that use of bioprostheses is associated with increased risk of SVD. Chance of SVD decreases with older age at implantation, therefore at a certain age, the risk of SVD and reoperation from bioprostheses will be lower than the risk of bleeding from mechanical valve.…”

Surgical management of valve disease in the early 21st century

“…Current data suggest that actuarial freedom from re-operation due to structural valve deterioration at 15 years is ca 75% in the aortic position and 65% in the mitral position. 10,11 Age-and health-related choice…”