910-17 The Appropriate Choice of a Cardiac Valve Prosthesis in Elderly Patients

Abstract

The long-term durability of the Carpentier-Edwards bioprosthesis in elderly patients exceeds 90% at the end of the first decade. This extensive and long-term experience provides further impetus for the continued use of this valve substitute with these patients. From October 1977 to June 1994, 700 patients 70 years of age and over underwent valve replacement using a Carpentier-Edwards porcine bioprosthesis. Ages ranged from 70 to 93 years with a mean of 75.9 ± 4.2. There were 398 men (56.9%) and 302 women (43.1%). Preoperatively, 98.7% of the patients were in New York Heart Association functional class III or IV In 74 patients (1 0.6%)the surgery represented a reoperation. There were 188 126.9%) isolated aortic valve replacements, 109 (15.6%) iSOlated mitral valve replacements, and 403 (57.6%) combined procedures which included the replacement of at least one valve. There were 42 (6.0%) double valve replacements in the series. Surgery was performed as an emergency in 42 patients (6.0%). Hospital mortality was 10.1% (7l patients) with 629 hospital survivors. There were 661 valves at risk. Follow-up extended from one month to 15.4 years with a mean of 48.1 months. The cumulative follow-up was 2,518.7 patient-years. A total of six valves failed from structural deterioration, one in the aortic and five in the mitral site ( p < 0.004). Actuarial freedom from valve structural deterioration at six years was 99.0 ± 0.5% standard error of the mean (SEM; 180 valves at risk) and 93.0 ± 3.5% SEM (eight valves at risk) at 12 years. Gender did not influence structural deterioration; however, valve site did ( p < 0.004). The results of this large and long-term experience reinforces the continued use of this device in elderly patients. The paucity of valve failures and a demonstrated enhanced quality of life experienced by hospital survivors provides further evidence for the use of the Carpentier-Edwards bioprosthesis in elderly patients with acquired valvular heart disease.