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18-Year Experience with the Carpentier-Edwards PERIMOUNT Standard Aortic Valve at a Single Japanese Center
Koichi Arinaga, Koji Akasu, Hiriyuki Saisho, Toru Takaseya, Kumiko Wada, Hidetoshi Akasi, Hiroyuki Tanaka.
Kurume University School of Medicine, Kurume, Japan.

18-Year Experience with the Carpentier-Edwards PERIMOUNT Standard Aortic Valve at a Single Japanese Center Background: The aim of this study was to evaluate the long-term results of the Carpentier-Edwards Pericardial (CEP) Standard valve at the aortic position. Methods: From January 1996 to December 2010, 275 patients who underwent aortic valve replacement with the CEP valve were enrolled. A 19-mm valve was used in 42 patients, 21-mm valve in 103 patients, 23-mm valve in 97 patients, and 25-mm valve in 33 patients. The early and late results were evaluated. Echocardiography was performed at follow-up in 191 of 270 late survivors for a mean duration of 6.3 ± 3.2 years. Left ventricular mass index (LVMI), mean pressure gradient (MPG), and effective orifice area index (EOAI) were measured. Results: There were 5 early deaths (early mortality rate , 1.82%). Among the 270 survivors, 255 (94.4%) were followed-up for a mean duration of 7.4 years (range, 18 months to 17.2 years) for a total of 2037 patient-years. There were 80(29.6%) late deaths during the follow-up period. Cardiac death and valve-related death occurred in 35 patients. Actuarial survival at 10, and 15 years was 63.6% and 45.3%, respectively. Thromboembolism was observed in 17 patients (0.83%/patient-year), prosthetic endocarditis in 3 patients (0.15%/ p-y), structural valve deterioration in 6 patients (0.29%/ p-y), and reoperation in 9 patients (0.44%/p-y). Actuarial freedom from thromboembolism, prosthetic endocarditis, structural valve deterioration and reoperation at 15 years was 83.7, 98.7, 85.1 and 77.9%, respectively. Echocardiography revealed acceptable pressure gradients across the valve prosthesis in each valve size. MPG was 12.0 ± 3.5 mmHg (19mm), 9.9 ± 3.4 mmHg (21mm), 11.4 ± 6.4 mmHg (23mm), and 9.7 ± 2.5 mmHg (25mm). EOAI was 0.83 ± 0.13 cm2 (19mm), 1.00 ± 0.20 cm2 (21mm), 1.05 ± 0.22cm2 (23mm), and 1.11 ± 0.21 cm2 (25mm). LVMI decreased significantly in all valve sizes. Conclusion: The long-term results of CEP bioprosthesis in the aortic position were satisfactory. The hemodynamic performance of the CEP bioprosthesis is maintained even as late as 18 years after implantation.

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