Original articleAdult cardiacLong-Term Durability of Bioprosthetic Aortic Valves: Implications From 12,569 Implants
Section snippets
Patients
From June 1982 to January 2011, 12,569 patients underwent AVR using PERIMOUNT bioprosthesis models 2700PM (n = 310) or 2700 (n = 12,259) at the Cleveland Clinic. In 3,319 patients (26%), AVR with this prosthesis was an isolated procedure; in 9,250 (74%), it was combined with concomitant procedures, such as coronary artery bypass grafting (48%), thoracic aortic surgery (21%), and mitral valve surgery (20%; Table 1). In 11,741 patients (93%), the native aortic valve was replaced, and this was
Overall Risk of Prosthesis Explantation
A total of 354 prostheses were explanted during follow-up, 41% related to endocarditis and 44% related to SVD. Diverse causes made up the remaining 14%, with less than 1% attributable to valve thrombosis.
Instantaneous risk of explantation for any cause was characterized by an early decreasing phase of risk followed by a late rising phase (Fig 1A). This overall temporal pattern of risk resulted from different cause-specific time-varying risks of reoperation for endocarditis versus SVD (Fig 1B).
Principal Findings
Aortic valve replacement with the PERIMOUNT bioprosthesis is associated with long-lasting durability. In older patients, explantation for SVD is rare and unlikely to be affected by valve size or implant technique. Structural valve deterioration is more common in younger patients; however, durability in those younger than 60 years is good, with 55% freedom from explant for SVD at 20 years. In younger patients, severe prosthesis–patient mismatch was associated with increased risk of explant for
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