Objectives : The long-term outcome after aortic valve replacement with the Carpentier-Edwards Perimount valve was studied, with special attention for the effect of patient-prosthesis mismatch (PPM) on survival and cardiac-related hospital readmission.
Methods : From 1985 to 2003, all patients receiving a CE-Perimount valve for single aortic valve replacement were reviewed, including emergent and salvage procedures, redo cases and cases with concomitant CABG. Analysis included univariate analysis of variance, chi-square testing, Kaplan-Meier survival analysis and multivariate modelling using logistic regression and Cox proportional hazards analysis. Reliable effective orifice area (EOA) values for the Perimount valve were derived from linear regression analysis using both in vivo echocardiographic and in vitro data (Fig. 1). Moderate and severe PPM were defined as an EOA-index below 0.85 and 0.65 respectively.
Results : A total of 506 patients were collected. Mean age was 73,3 years (range 58-87 years). Associated surgical procedures included CABG in 233 cases (46%), 48 cases (9,5%) were redo. Mean follow-up was 72 +/- 58 months (range 1 - 18,6 years). Three month mortality was 8,9% and 177 deaths (35%) occurred later. Actuarial survivals at 5, 10, and 14 years were 76,9%, 53,1% and 29,8% respectively. At 14 years (with still 40 patients in follow-up) freedom from valve reoperation was 90,3%, freedom from structural valve deterioration was 86,5%, freedom from thromboembolism was 81,1%, and freedom from endocarditis was 98,9%. The incidence of severe PPM was 0,2% (1 patient). Moderate PPM was present in 111 patients (21,8%), while 394 patients (78%) had no mismatch. Multivariable analysis identified age, diabetes, unstable angina, absence of sinus rhythm and CPB duration as significant predictors for overall mortality. Univariately, PPM had a significant effect on survival (Fig. 2), but in multivariable analysis PPM was no longer a significant predictor.
Conclusions : The CE-Perimount bioprosthesis provides good long-term outcome. Occurrence of severe PPM is a rare event. In multivariable analysis, moderate PPM did not influence survival or cardiac-related hospital readmission.
Fig. 1
Fig. 2
