Division of Cardiovascular and Thoracic Surgery, Pontchaillou Hospital, Rennes, France.
Ann Thorac Surg. 2012 Oct;94(4):1191-7. doi: 10.1016/j.athoracsur.2012.05.003. Epub 2012 Jul 7.
We evaluate the clinical results of the Carpentier-Edwards supraannular (CE SAV) aortic bioprosthesis at long-term follow-up (over 25 years).
Between 1983 and 1994, 1,002 CE SAV prostheses were implanted. Data were prospectively collected, retrospectively analyzed, and stratified by age groups at the time of surgery (group 1, ≤60 years; group 2, 61 to 70 years; group 3, >70 years), using both the actuarial and the "actual" (cumulative risk) methods.
The operative mortality was 11.3% (valve-related in 2 cases). Follow-up included 8,164.09 patient-years (average 13.7±6.6 years, up to 26.9 years). Overall survival at 25 years was significantly higher in group 1 (p<0.001). Freedom from structural valve deterioration (SVD) at 15 years was 85.9% (actuarial) and 94.8% (actual). Freedom from reoperation for SVD was 91.8% (actuarial) and 97% (actual). There were no significant differences in valve-related endpoints among group 2 and group 3. Death was valve-related in 11.3%. Younger age at surgery was associated with higher incidence but not earlier presentation of SVD. Freedom from any valve-related complication at 15 years was 23.6%, 66%, and 68% in groups 1, 2, and 3 (actuarial), and 38.9%, 76.1%, and 81.2%, respectively (actual) (p=0.6 among groups 2 and 3).
The CE SAV bioprosthesis provides similar outcomes (SVD and reoperation) in patients aged 61 to 70 years and older individuals. Use of a bioprosthesis is justified in patients older than 60 years. Younger patients may be rightfully informed over the expected durability of the prosthesis.
我们评估了 Carpentier-Edwards 瓣上型（CE SAV）生物主动脉瓣在长期随访（超过 25 年）中的临床结果。
在 1983 年至 1994 年间，植入了 1002 个 CE SAV 假体。数据是前瞻性收集的，回顾性分析的，并按手术时的年龄组分层（组 1，≤60 岁；组 2，61 至 70 岁；组 3，>70 岁），使用生存分析和“实际”（累积风险）方法。
手术死亡率为 11.3%（2 例与瓣膜有关）。随访包括 8164.09 患者年（平均 13.7±6.6 年，最长 26.9 年）。25 年时，组 1 的总生存率明显更高（p<0.001）。15 年时，无结构性瓣膜退化（SVD）的生存率为 85.9%（生存分析）和 94.8%（实际）。无 SVD 再手术的生存率为 91.8%（生存分析）和 97%（实际）。组 2 和组 3 之间在瓣膜相关终点方面没有显著差异。死亡与瓣膜有关的有 11.3%。手术时年龄较小与 SVD 的发生率较高有关，但与发病时间较早无关。15 年时，无任何瓣膜相关并发症的生存率分别为组 1、组 2 和组 3 的 23.6%、66%和 68%（生存分析）和 38.9%、76.1%和 81.2%（实际）（组 2 和组 3 之间无显著差异）。
CE SAV 生物主动脉瓣在 61 岁至 70 岁和年龄较大的患者中提供相似的结果（SVD 和再次手术）。对于年龄大于 60 岁的患者，使用生物假体是合理的。年轻患者可能会正确地了解假体的预期耐久性。
