Five-year follow-up of Hancock pericardial valves: management of premature failure

The last generation of pericardial valves in the aortic position: ten-year follow-up in 589 patients

BACKGROUND

The first generation of pericardial valves has been withdrawn from the market because of excessively high rates of premature failure. With its original design, the Carpentier-Edwards pericardial valve has promised improved results.

METHODS

In our institution, 589 patients underwent an isolated aortic valve replacement with a Carpentier-Edwards pericardial bioprosthesis between July 1984 and December 1993. The patients' mean age was 67.5 +/- 11.2 years, and 49% of the patients were in New York Heart Association clinical class III or IV. The operative mortality rate was 2.3% (14 of 595). All patients but 4 were followed up for an average of 4.1 years after their operation, and total follow-up was 2,408 patient-years.

RESULTS

At the time of the study, more than 85% of the patients were in New York Heart Association class I or II. There were 79 late deaths. After 10 years, the actuarial survival rate was 71% +/- 7%. Nineteen patients died of valve-related causes (3 endocarditis, 7 thromboembolic complications, 1 structural failure, and 8 sudden deaths). The actuarial rate of freedom from valve-related death was 94% +/- 3% at 10 years. Valve-related complications included 23 thromboembolic episodes (0.9% per patient-year), 14 endocarditis (0.5% per patient-year), 9 reoperations (0.4% per patient-year), and 4 structural valve failures with calcification and stenosis (0.2% per patient-year). After 10 years, freedom from valve-related complications was 84% +/- 6%, from reoperation 97% +/- 2%, and from valve failure 96% +/- 4%.

CONCLUSIONS

Because of its low rate of valve-related events at 10 years and low rate of structural deterioration with no leaflet tears, this prosthesis is an outstanding choice for patients who need tissue valves and for patients aged 60 years or older.

Management of intracardiac device recalls: a consensus conference. Participants of the Consensus Conference. North American Society of Cardiac Pacing and Electrophysiology (NASPE)

The incidence of cardiac device recalls seems to be increasing, in part due to increasing complexity, but also due to greater public awareness and regulatory overview. Manufacturers are responsible for postmarket surveillance of their implanted products; evidence for poor performance is usually evaluated by a Physician Advisory Committee (PAC) and unacceptable failure rates or modes prompt the issuance of a recall. A Consensus Conference was held March 6, 1995, in Toronto, Ontario, to discuss the management of cardiac device recalls after the provincial Ministry of Health issued unique guidelines regarding a recent lead problem. Various stakeholders expressed their views and concerns: the federal regulatory body, the provincial Ministry of Health and hospital association, manufacturers, hospital legal counsel, patient and media advocates, and physicians from the United Kingdom, the United States, and Canada. Specific recommendations included: the establishment of a National (or regional) Pacemaker (device/lead) Registry interposed between the manufacturer and the federal authority; the creation of a Recall Task Force (RTF) to deal with specific problems distinct from the manufacturers' PAC; emphasis on patient responsibility for obtaining regular follow-up and maintaining contact by a pacemaker passport system as exists in Europe; and the fair assignment of costs involved in a recall with specific emphasis on appropriate compensation for physicians and clinic personnel.

Carpentier-Edwards pericardial bioprosthesis in aortic position: long-term follow-up 1980 to 1994

Aortic valve replacement with Carpentier-Edwards pericardial bioprosthesis was associated with excellent midterm clinical results. Long-term evaluation, however, remained to be determined. We reviewed the first 124 patients who underwent aortic valve replacement with a Carpentier-Edwards bioprosthesis at the Hôpital Broussais between 1980 and 1985. There were 67 males (54%) and 57 females (46%). The mean age at operation was 65 years (range, 18-83 years). The operative mortality (30 days) was 4%. All but 2 patients were followed up for an average of 7.7 years and a total of 973 patient years. There were 45 late deaths (4.7%/patient-year) of which 16 were valve-related (1.7%/patient-year). The actuarial survival rate was 49.9% at 12 years. The actuarial rate for freedom from valve-related mortality was 78.3% at 12 years. There were 7 thromboembolic events in 5 patients and 3 anticoagulation-related hemorrhages. Freedom from structural valve deterioration was 100% at 12 years and 83.3% at 13 years. We conclude that implantation of Carpentier-Edwards pericardial bioprosthesis in aortic position is associated with an excellent long-term clinical outcome. It is believed that the improved results of this valve result from the following original features: fully flexible stent, distensible struts, infrastent tissue mounting, optimal tissue orientation, and improved preservation.

Long-term evaluation of the Carpentier-Edwards pericardial valve in the aortic position

From July 1980 to December 1985, 124 patients underwent isolated aortic valve replacement with the Carpentier-Edwards pericardial bioprosthesis. The mean age of the patients was 64.9 +/- 13.1 years. All patients but one (0.7%) were followed for an average of 5.52 +/- 0.21 years after the operation and follow-up totaled to 677 patient-years. There were six early deaths (30-day mortality of 4.8%) and 25 late deaths (3.7% +/- 0.7% patient-year). After 9 years the actuarial survival rate was 64% +/- 14%. Six patients died of valve-related deaths (three anticoagulant-related hemorrhage, one endocarditis, one thromboembolic complication, and one sudden death) for an actuarial rate of 95% +/- 5% patients free of valve-related death at 9 years. Valve-related complications included five thromboembolic episodes (0.7% +/- 0.3% patient-year), eight anticoagulant-related hemorrhagic complications (1.2% +/- 0.4% patient-year), and two reoperations (0.3% +/- 0.2% patient-year). After 9 years, freedom from thromboembolic events was 96% +/- 4%, that from anticoagulant-related hemorrhage was 93% +/- 5%, and that from reoperation was 98% +/- 2%. There was no structural deterioration of the valve. We conclude that the Carpentier-Edwards pericardial prosthesis has a low incidence of valve-related complication and mortality within the 9-year time frame of this study.