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- W1738273193 abstract "The Carpentier-Edwards bioprosthesis was implanted in 369 patients (414 valves) between May 1977 and December 1987 (age 67.2 ± 0.5 years); 242 had aortic valve replacement, 80 had mitral valve replacement, 44 had multiple valve replacement, of which 41 were aortic and mitral valve replacement, 2 had isolated tricuspid valve replacement, and 1 had a pulmonary valve replacement. The selection criteria were the following: shorter life expectancy (253 patients) or contraindications to anticoagulants for organic (113 patients) or psychologic (38 patients) reasons, or both. The early mortality rate was 11.1% (aortic valve replacement, 9.1%; mitral valve replacement, 12.4%; aortic and mitral valve replacement, 23.1%). Total cumulative follow-up was 1456 pt-yr (mean 4.4 years, range 1 to 148 months), and the patient evaluation was 99.5% complete. Late mortality was 4.9%/pt-yr. Five-year survival was 70.4% ± 2.7% overall, 74.3% ± 3.2% after aortic valve replacement, 60.9% ± 6.2% after mitral valve replacement (p < 0.03), and 60.7% ± 8.1% after aortic and mitral valve replacement. Eight patients were reoperated on for primary tissue failure, and freedom from reoperation for structural valve deterioration was 97.5% ± 1.2% at 5 years and 95.6% ± 1.8% at 8 years. Failing aortic bioprostheses were explanted in four patients (0.4%/pt-yr) and mitral bioprostheses in seven (1.6% /pt-yr). No patient whose valve was inserted after the age of 70 had to be reoperated on for structural valve dysfunction. The probability of freedom from thromboembolism after 5 and 8 years of follow-up was 93.1% ± 1.6% and 92.2% ± 1.8%, respectively. The prevalence of anticoagulant-related hemorrhage was 0.8% /pt-yr (major 0.6%, minor 0.2%). Anticoagulants had to be maintained in 16.3% of the patients: 5.9% after aortic valve replacement, 35.7% after mitral valve replacement, and 45.8% after aortic and mitral valve replacement, while 80.0% were on a regimen of antiplatelet drug therapy. Prosthetic valve endocarditis happened in five patients (0.3%/pt-yr). Freedom from all valve-related morbidity and mortality, including hospital deaths, was 71.0% ± 2.7% at 5 years and 58.6% ± 4.6% at 8 years and was significantly better in the aortic valve replacement group (61.3% ± 6.6% at 8 years) compared with the mitral valve replacement group (54.4% ± 7.7% at 8 years; p = 0.04). This study confirms the satisfactory performance of the Carpentier-Edwards valve after aortic valve replacement in elderly patients. In mitral position, however, clinical performance is lower than in the aortic position, and the advantages of the biologic valve are often nullified by the necessity for long-term anticoagulation. (J Thorac Cardiovasc Surg 1992;104:1013-24)" @default.
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- W1738273193 date "1992-10-01" @default.
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- W1738273193 title "Use of the Carpentier-Edwards porcine bioprosthesis: Assessment of a patient selection policy" @default.
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- W1738273193 doi "https://doi.org/10.1016/s0022-5223(19)34686-0" @default.
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