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Biomedical subjects

L C Pelletier

Publications and source records attributed to L C Pelletier.

At least 109 records · Page 6Linked to original sources
PubMed1990

[The effect of cyclosporin on renal function following cardiac transplantation: should one lessen the toxicity?].

Between 1983 and 1988, 50 patients underwent cardiac transplantation at the Institut de Cardiologie de Montréal. During this period, four immunosuppression protocols were used, each including cyclosporine. A combination of cyclosporine and prednisone was used in the first 24 patients (group 1). Triple combination immunosuppression (cyclosporine, prednisone and azathioprine) was given perioperatively in 13 patients (group 2). The prophylactic use of rabbit antithymocyte globulin and late administration (4 days postoperatively) of cyclosporine to prevent early renal failure associated with cyclosporine therapy was chosen in 13 other patients (group 3). Owing to serious deterioration of renal function in 15 of the 24 group 1 patients, the serum creatinine levels reaching 255 +/- 51 mmol/L and the creatinine clearance 34 +/- 2 ml/min between 6 months and 4 years after transplantation, immunosuppression was modified to triple-combination therapy by the addition of azathioprine and a reduction of the serum levels of cyclosporine (group 4). Twelve of the 15 patients showed a substantial improvement in renal function from 3 to 18 months after these changes were introduced. No patient in groups 2 and 3 had late renal insufficiency, and in all group 3 patients renal function remained normal as in the immediate postoperative period. In conclusion, important modifications in protocol permitted a reduction of early and late renal failure due to cyclosporine after cardiac transplantation.

Adult↗
PubMed1990

Surgical treatment of the Wolff-Parkinson-White syndrome. Endocardial versus epicardial approach.

From 1983 to 1988, 51 patients with the Wolff-Parkinson-White syndrome underwent surgical ablation of an accessory conduction pathway, 25 by the classic endocardial approach and 26 by the epicardial technique supplemented by cryosurgery. In the endocardial and epicardial groups, the accessory pathway was in the left free wall in 22 and 18 patients, respectively, posterior septal in two and seven, and in the right free wall in one patient in each group. There was no early or late death in the endocardial group, and postoperative complications developed in five patients (20%). Pathway ablation was completely successful in 22 patients (88%), preexcitation recurred in two patients (8%), and one had recurrence of supraventricular tachycardia (4%). One of the failures occurred with a posterior septal pathway (50%), and the two others with a left free-wall pathway (9%). With the epicardial technique, there were no early deaths and one late death caused by atherosclerotic coronary artery disease. Five patients (19%) had postoperative complications. The pathway was ablated successfully in 22 patients (85%), preexcitation recurred in three patients (12%), and supraventricular tachycardia remained inducible in another patient despite disappearance of the delta wave. Three of those failures occurred with anterior left free-wall pathways (16%), but only one patient had recurrent supraventricular tachycardia (4%) requiring immediate reoperation, which was successful. In conclusion, although epicardial or endocardial approaches produced similar results, our observations suggest that left free-wall accessory pathways located high anteriorly may be ablated in a more reproducible way with the endocardial technique, whereas the epicardial approach appears easier for posterior septal pathways. We therefore believe that any surgeon beginning such surgery should be aware of the possibilities and limitations of each of the two techniques.

Adolescent↗
PubMed1989

Porcine versus pericardial bioprostheses: a comparison of late results in 1,593 patients.

From 1976 to 1988, 1,593 patients underwent valve replacement with a porcine (878 patients) or a pericardial bioprosthesis (715 patients). There were 701 aortic, 678 mitral, and 214 multiple-valve replacements. Follow-up was obtained for 1,559 patients (98%). Early mortality was 9% (79 patients) in the porcine valve group and 5% (37 patients) among patients with a pericardial valve (p less than 0.01). Late survival after replacement with porcine valves was 80% +/- 1% and 62% +/- 3% at 5 and 10 years, respectively. With pericardial valves, 5-year survival was 79% +/- 2%. Among valve-related complications, rates of freedom from thromboembolism, endocarditis, and hemorrhage after 6 years were similar for both valve groups. Freedom from reoperation at 6 years was also similar after aortic (96% versus 91%) or multiple-valve replacement (95% versus 88%). However, for mitral valve replacement, freedom from reoperation was significantly better with porcine valves than with pericardial valves at 6 years (92% versus 68%; p less than 0.001). This difference was mainly due to the Ionescu-Shiley valve, which accounted for 83% of primary tissue failures among pericardial bioprostheses implanted in the mitral position (10/12 patients). After 6 years, freedom from primary tissue failure of mitral valves was 92% +/- 2% with porcine and 70% +/- 11% with pericardial bioprostheses (p less than 0.0001). The degree of clinical improvement among survivors was similar with both valve types. Thus, in the aortic position, pericardial valves compare with porcine valves up to 6 years, whereas in the mitral position, the durability of the former is significantly less, mainly because of the suboptimal performance of the Ionescu-Shiley pericardial bioprosthesis.

Adolescent↗
PubMed1988

Lymphocyte subpopulation monitoring in cyclosporine-treated patients following heart transplantation.

Circulating lymphocyte subpopulations were studied in 18 consecutive patients treated with cyclosporine-prednisone immunosuppression during the first month following heart transplantation. Eleven patients showed no evidence of graft rejection. There were eight episodes of acute rejection demonstrated at endomyocardial biopsy in 7 patients. Three patients were treated with corticosteroids, 3 were treated with rabbit antithymocyte globulin (RATG), and 1 died before treatment (early mortality: 5.6%). Using the monoclonal antibody technique, 150 determinations of lymphocyte subpopulations were performed and were correlated with 72 endomyocardial biopsy specimens. Cyclosporine immunosuppression caused a significant (p less than 0.05) decrease in total lymphocyte count (38%) and in the number of OKT3 (52%) and OKT4 cells (55%). During acute rejection, total lymphocytes and OKT3, OKT4, and OKT8 cells all increased significantly, but the T4 to T8 ratio did not change significantly. Treatment of rejection with corticosteroids resulted in a moderate but not significant decrease in all T-cell types, whereas RATG caused a marked but not selective decrease in all T-cell groups. In conclusion, T cells decrease with cyclosporine immunosuppression and with treatment of rejection and increase at onset of rejection, but the T4 to T8 ratio has no predictive value for the diagnosis and severity of rejection, and the sensitivity of the method does not permit its use to assess the degree of immunosuppression with cyclosporine following heart transplantation.

Adolescent↗
PubMed1988

Aortic valve replacement with the Carpentier-Edwards pericardial bioprosthesis: clinical and hemodynamic results.

From 1981 to 1987, 189 patients underwent isolated aortic valve replacement with the Carpentier-Edwards bovine pericardial bioprosthesis. There were 9 early deaths (30-day mortality of 4.8%) and 18 late deaths (3.3% pt-yr). After 5 years, the actuarial survival rate was 81.9%. All patients but one were followed for an average of 37 months after operation, and follow-up totaled 551 patient-years. Valve-related complications included 12 thromboembolic episodes (2.2%/pt-yr), 7 endocarditis (1.3%/pt-yr), 2 hemorrhages due to anticoagulation (0.4%/pt-yr), and 3 reoperations (0.5%/pt-yr). After five years, freedom from thromboembolic events was 91%, that from reoperation was 98%, and 87% for all valve-related complications. There was no primary tissue failure of the valve. Before operation, 55% of the patients were in functional Class III or IV, 97% of the survivors were in Class I or II after valve replacement. Hematological evaluation of 77 patients, an average of 18 months postoperatively, showed no clinically significant hemolysis. Postoperative hemodynamic studies in 28 patients showed mean aortic pressure gradients across the prosthesis at rest ranging from 24 mmHg with the smaller (19 mm) to 11 mmHg with the larger (25 mm and more) valves, and effective orifice areas ranging from 1.0 to 1.9 cm2, respectively. Thus, the Carpentier-Edwards pericardial bioprosthesis appears to be a reliable and hemodynamically effective substitute for replacement of the aortic valve.

Adult↗
PubMed1987

[Surgical treatment of ventricular tachycardia].

We present our clinical experience with 37 patients presenting with ventricular tachycardia who, between 1980 and 1986, underwent subendocardial resection, guided by per-operative mapping in 34 cases. An aneurysm of the left ventricle was present in 23 patients (62%), and an akinetic area in the remaining 14 patients. In every case the cause of ventricular tachycardia was an ischaemic heart disease. Prior to surgery, the global isotopic ejection fraction was 27 +/- 11% and the left ventricular end-diastolic pressure was 21 +/- 8 mmHg. The most common site of origin of the arrhythmia was the septum (26 cases, 77%). The mean area of resection was 26 +/- 16 cm2. Resection of a ventricular aneurysm was also performed in 23 cases, and 22 patients underwent coronary bypass. There were 4 early deaths (operative mortality rate : 10.8%) and 4 late deaths. The actuarial survival rate was 89 +/- 5% at 6 months and 72 +/- 9% at 24 months. One-half of the deaths was due to recurrence of the ventricular tachycardia. A post-operative electrophysiological study conducted in 30 patients proved negative in 28 (93%). Altogether, there were 6 immediate or late failures (16.2%) after a mean follow-up period of 18 months. The probability of a relapse-free, medication-free life or sudden death was 86 +/- 6% after 6 months and 82 +/- 7% after 24 months. The quality of life of the survivors war remarkable, since 86% of them (25/29 patients) remained in functional class 1 or 2 after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1987

Left ventricular aneurysm with predominating congestive heart failure. A comparative study of medical and surgical treatment.

From 1979 to 1985, 109 patients were treated for congestive heart failure caused by postinfarction left ventricular aneurysm. Congestive heart failure was predominant in all patients at the time of diagnosis, 73% of whom were in Functional Class III or IV. Left ventricular end-diastolic pressure averaged 23.8 +/- 0.8 mm Hg (mean +/- standard error of the mean), total ejection fraction 29.7% +/- 1.0%, and telediastolic volume of the aneurysm 76.2 +/- 5.8 ml. Aneurysmectomy was performed in 49 patients (45%), whereas the remaining 60 patients were treated medically. The two groups did not differ in regard to clinical and hemodynamic data on admission, except for a more extensive coronary artery disease in the surgical group. Follow-up was obtained for all patients (100%) and averaged 48 +/- 3 months. Actuarial survival curves were similar, and the 5-year survival rates for surgical and medical groups were 70 +/- 7% and 64% +/- 7%, respectively (not significant). However, the 5-year complication-free rate was significantly (p = 0.05) higher among surgical patients (52% +/- 8%) than among the medical group (31% +/- 7%). Multivariate analysis showed the following variables to influence survival independently (p less than 0.05): contractile segment ejection fraction, right ventricular failure, antecedents of cardiac arrest or cardiogenic shock, and corrected contractile score. Independent variables decreasing the risk of cardiac-related complications and death (p less than 0.05) were as follows: surgical treatment, shorter interval between initial infarction and diagnosis of aneurysm, and absence of right ventricular failure. Functional improvement was directly related to surgical treatment and to residual segment contractile score (p less than 0.05). Thus, in patients with congestive heart failure caused by left ventricular aneurysm, surgical treatment improved the quality of life and prognosis for cardiac-related complications, but did not increase overall survival, compared to medical management of similar patients.

Adult↗
PubMed1987

Clinical and hemodynamic assessment of the Omniscience prosthetic heart valve.

From 1980 to 1985, 154 Omniscience valve prostheses were implanted in 132 patients (mitral in 72, aortic in 33, and both in 27), 81 women and 51 men, aged 22 to 72 years. There were 13 early deaths (30 day mortality of 9.8%) and nine late deaths. The actuarial survival rate was 79.1% after 4 years, and survival rates after aortic, mitral, and multiple valve replacement were 71.8%, 80%, and 85.2%, respectively. After a postoperative follow-up period averaging 27 months, 96% of the survivors were in Class I or II. The linearized incidence of thromboembolism, hemorrhagic episodes, and reoperation was 3.8%, 3.4%, and 2.3% per patient-year, respectively. After 4 years, freedom from valve-related mortality, valve-related mortality and reoperation, thromboembolic episodes, and all valve-related complications was 93%, 89%, 88%, and 70%. Moderate hemolysis with increases of reticulocyte count and serum lactic dehydrogenase above normal values was found in 80% of the patients, but only one had hemolytic anemia. In 22 patients, the maximal opening angle of the prosthetic disc averaged 54 +/- 11 degrees. Postoperative hemodynamic evaluation was obtained in five patients with aortic prostheses and in 13 with mitral prostheses. Mean aortic gradient and effective orifice area averaged 17.6 mm Hg and 1.2 cm2 at rest and increased to 18.8 mm Hg and 1.7 cm2 with exercise. With mitral prostheses, these values averaged 6.5 mm Hg and 1.9 cm2 at rest and 15.4 mm Hg and 2.1 cm2 with exercise. Thus excellent clinical improvement is obtained with the Omniscience prosthesis; however, the hemodynamic performance of the valve and opening of the tilting disc are suboptimal, causing the prosthesis to be moderately obstructive to blood flow.

Actuarial Analysis↗
PubMed1986

Morbidity and mortality of coronary artery surgery after the age of 70 years.

From January, 1977, to December, 1983, 102 patients aged 70 years or more underwent isolated aortocoronary bypass surgery. They were compared with a group of 100 consecutive patients of less than 70 years of age who underwent the same surgical procedure in 1983. The older group was consistently more diseased in regard to clinical incapacity, unstable angina, the number of coronary arteries involved, and the number of coronary bypasses performed. The incidence of substantial stenosis of the left main coronary artery among the older patients was twice that in the younger ones. There were 7 early deaths in the older group and none in the younger patients. The cause of death was cardiac in 3 patients and noncardiac in 4. A total of 54 complications occurred in 39 older patients and 32 in 27 younger patients. The incidence of cardiac complications was similar in both groups (18 in the older and 17 in the younger). However, noncardiac complications were significantly (p less than 0.0001) more common in older patients (32) than in the younger patient group (7). The most frequent in the older group were cerebral (14), sternal (6), and respiratory (5) complications. Thus, the operative risk of aortocoronary bypass grafting is increased after the age of 70 years, particularly because of noncardiac complications, which are responsible for more than half of the early deaths. Careful selection of candidates for surgical treatment in this age group is mandatory, and particular attention should be given preoperatively to the search for noncardiac disorders to decrease the incidence of these operative complications.

Adult↗
PubMed1986

[The surgical alternative in the treatment of terminal cardiomyopathies: cardiac transplantation].

Between April 1983 and November 1985, 14 patients have undergone a heart transplant, or 10 men and 4 women, aged from 17 to 55 years. The surgical indication was a cardiomyopathy in terminal evolutive phase, of which the etiology was ischemia in 8 cases, congestion in 5 cases and rheumatism in one case. There was one operative death (7.1%) from acute rejection and a late death secondary to chronic rejection. The actuarial rate of survival at one and 2 years was 81.9%. Post-operative complications, most frequent at an early stage, were arterial hypertension (9 cases), rejection (8 cases) and renal insufficiency (6 cases). During an average post-operative evolution of 13 months, 17 rejection episodes occurred in 10 patients (71.4%) and 5 patients (35.7%) presented with 7 infectious episodes, one of them severe. Cyclosporin's toxicity appeared in the immediate post-operative period by an always reversible increase of the bilirubin and creatinin levels. On a long term, all patients present with arterial hypertension, accompanied by a moderate renal insufficiency (creatinin between 2.2 and 2.4 mg%). Among the survivors, 9 patients (75%) remain completely asymptomatic and have resumed normal physical activities. Cardiac transplantation has therefore become a valid therapeutic alternative, able to greatly improve survival and the functional condition of patients with terminal cardiomyopathy.

Adolescent↗
PubMed1985

Surgical treatment of the post-infarction left ventricular aneurysm. Factors influencing early and late results.

The early and late results of a 4 year surgical experience with 119 left ventricular aneurysms (LVA) are analyzed. The most common indication for surgery was angina in 78 patients, congestive heart failure (CHF) in 34, arrhythmia in 5 and recurrent embolism in 1. One patient was operated on prophylactically. There were 112 "anterior" and 7 "posterior" aneurysms. Preoperative ventricular function was significantly worse in the CHF group. LVA resection was carried out in 105 patients and a plicature in other 14. In 92 cases the procedure was combined with a myocardial revascularization. Additional cardiac procedures were performed in 14 patients. Overall early (5.9%) and late mortality (18.7%) was significantly higher in the CHF group than in the angina group (14.7% versus 1.3%, p less than 0.01, and 37.9% versus 12.9%, p less than 0.01, respectively). Associated surgical procedures (p less than 0.001) and acuity of the LVA (p less than 0.05) also increased the operative risk. The 5 year-survival was better for the angina group (85.7 +/- 4%) and arrhythmias group (80 +/- 22%) than for CHF patients (46.7 +/- 19%) (p = 0.052). Functional improvement was uniform between survivors of all groups (73.2%). In 15 patients with pre- and postoperative studies hemodynamic parameters were found improved although only a global contractile score did reach significant levels (p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Myocardial revascularization after failure of percutaneous transluminal coronary angioplasty.

From 1980 to 1983, 299 procedures for percutaneous transluminal coronary angioplasty were performed in 265 patients. The procedure failed in 88 patients, 72 of whom underwent myocardial revascularization within 1 week following the angioplasty attempt. Operation on an emergency basis was required in 35 patients because of a major complication during or after coronary artery dilatation, whereas the remaining 37 patients underwent elective operation following failure without complication. Coronary occlusion occurred in 23 patients, coronary dissection without occlusion in four, perforation of the coronary artery in one patient, and no visible angiographic changes accounted for the severe myocardial ischemia in the remaining 7 patients. Signs of acute myocardial infarction were present preoperatively in 13 of the 35 patients (37.1%) who underwent emergent operation. Among the factors analyzed, only the absence of collateral circulation and the extent of coronary disease were directly related to the development of complications with percutaneous transluminal coronary angioplasty. There were no early or late deaths in this series. Postoperative complications occurred in seven patients (20%) of the group undergoing emergency operation and in none of the group having elective operation. New postoperative myocardial infarction developed in three patients (8.6%). In six of the 13 patients with preoperative evidence of necrosis, the electrocardiogram returned to normal without other signs of acute infarction after the operation, whereas myocardial infarction was complete in the remaining seven patients. Thus, patients who have complications from percutaneous transluminal coronary angioplasty should undergo immediate operation; for those in whom the procedure fails without complication, surgical treatment can be postponed and performed electively later on if indicated by the clinical incapacity of the patient.

Adult↗
PubMed1984

Five-year clinical experience with the Omniscience cardiac valve.

Clinical data on the Omniscience cardiac valve prosthesis (sizes 19 to 31 mm) were obtained from 326 patients (155, aortic valve replacement [AVR]; 125, mitral valve replacement [MVR]; and 46, double-valve replacement) during a five-year period (650 patient-years) with 96% accountability. Mean age was 56 +/- 12 years, and 40% (130) of the patients were 61 years old or older. Thirty-one percent (101) had prior or concomitant coronary artery bypass grafting procedures, 9% (28) had a previous malfunctioning prosthesis, and 17% (57) had other cardiac surgical procedures. Eighty percent were in New York Heart Association (NYHA) Functional Class III or IV preoperatively. Early mortality was 10% (34). Five-year actuarial thrombus-free rate is 96% for patients who underwent AVR and 95% for patients having MVR. Postoperatively, 89% (172/193) were in NYHA Class I or II, and 84% (163/193) improved by at least one Functional Class. A significantly high proportion of the postoperative hematological values fall within normal ranges: red blood cell count, 94% (176/187); hematocrit, 88% (166/188); and hemoglobin, 93% (176/190). Ninety-eight percent (287/292) are free from clinical anemia. Four of the 5 patients with clinical anemia had a preoperative history of this condition. Levels of lactic dehydrogenase in 3 patients suggested the probable presence of clinically significant hemolysis, although all 3 have normal hematological values. Actuarial five-year survival for patients who underwent AVR or MVR are similar (82% and 80%, respectively), indicating satisfactory and comparable levels of safety and performance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Coronary artery bypass surgery in the eighth decade of life: experience with 101 patients.

Coronary artery bypass grafting (CABPG) has become a frequent procedure among elderly patients. Our experience with 101 consecutive patients aged 70 or older undergoing isolated CABPG is reviewed. Most were male (73.3%) and almost half were in an unstable preoperative condition (43.6%). Groups were made up according to sex and the type of angina with a view to assessing differences in operative risk and in long-term results. Unstable angina was more prevalent in females (63% versus 36.5%) (p less than 0.01). Early mortality rate (overall 5.9%) was significantly greater for females (p less than 0.05) and unstable angina (p less than 0.05). Late mortality was, in contrast, greater in males (p less than 0.05) and incomplete revascularization was also found to be a predictor of poor prognosis (p less than 0.001). The incidence of non-fatal postoperative complications was very high (42.1%) and there were no differences between the groups. Neither were differences found in regard to the functional long-term course. We conclude that a more aggressive approach is warranted in elderly patients free from severe systemic diseases although a somewhat higher perioperative mortality and morbidity must be expected.

Aged↗
PubMed1984

Factors influencing thromboembolic complications in Omniscience cardiac valve patients.

Clinical data were gathered over five years (650 patient-years) for all 155 aortic valve replacement, 125 mitral valve replacement and 46 double valve replacement patients implanted with the Omniscience cardiac valve prosthesis at three North American medical cent es. Mean age was 56 +/- 12 years, 80% were preoperatively in NYHA class III or IV, and 57% had previous or concomitant cardiac surgery. Data were evaluated for the incidence of thromboembolic complications. During the late postoperative period, transient ischaemic episodes occurred in six patients (0.92% per patient-year). The five-year actuarial thrombus-free rate for serious thromboembolic complications (valve thrombosis or thromboembolism with residual effects) for aortic valve replacement patients is 96% and 95% for mitral valve replacement patients. For patients experiencing any transient or serious thromboembolic complication, 35% had a compromise of coumadin anticoagulation shortly before the thromboembolic event, 60% had a history of atrial fibrillation, and 76% a history of rheumatic heart disease. Statistically, these rates are significantly higher compared with the original valve population. The low incidence of thromboembolic complications over this five-year clinical study demonstrates a commendable degree of safety and performance for the Omniscience valve.

Actuarial Analysis↗
PubMed1984

[Open-heart surgery after 70 years of age. Results in 136 patients].

Between 1975 and 1983, 136 patients aged over 70 underwent open heart surgery: aorto-coronary by-pass in 67 cases, valve replacement in 46 cases, combined valve and coronary surgery in 20 cases, resection of a left ventricular aneurysm in 2 cases and closure of a ruptured septum in 1 case. There were 13 deaths in the short-term (9.6%). Operative mortality for aorto-coronary by-pass was 4.5%, and that of valve replacement 4.4%, whereas for the combined procedures it was 35%. Non-fatal post-operative complications were frequent, occurring in 40% of patients. Life-table analysis showed 77% survival at 5 years. Of the 111 patients who left hospital, only one was lost to follow-up. At an average follow-up of 26 months, there were 84 patients in functional class I, 17 in class II and 9 in class III. Complications related to the presence of a prosthetic valve occurred in only 3 patients, none of whom required reoperation during the follow-up period. In the elderly, open heart surgery can therefore be carried out at relatively low risk, except where combined procedures are concerned. The long term history, together with the degree of functional improvement achieved, justify cardiac surgery even in the elderly.

Aged↗
PubMed1984

Five-year evaluation of the Carpentier-Edwards porcine bioprosthesis.

The Carpentier-Edwards porcine bioprosthesis compares favorably to other value substitutes, with a low incidence of valve-related complications after up to 6 years' follow-up. From April, 1976, to February, 1978, 397 prostheses were implanted in 355 patients at the University of British Columbia and the Montreal Heart Institute: aortic valve replacement (AVR), 155; mitral valve replacement (MVR), 154; tricuspid valve replacement (TVR), five; multiple replacement (MR), 41 patients. Previous cardiac operations had been performed in 58 patients (16.3%). Concomitant cardiac procedures, including myocardial revascularization, were performed in 66 patients (18.5%). The 30 day mortality was 8.7% (31 patients (AVR, 4.5%; MVR 9.0%; TVR 20%; MR 21.9%). The cumulative follow-up was 1,367 patient-years (range 6 to 81 months, mean 51 months). The late mortality is 3.9% per patient-year (AVR 3.4%, MVR 3.6%, MR 6.3%). The long-term valve-related complication rates (expressed as percent per patient-year and number of events) are as follows; thromboembolism (AVR 1.1 [seven], MVR 1.7 [10], MR 3.2 [four]; prosthetic valve endocarditis (AVR 0.6 [four], MVR 0.3 [two], MR 1.6 [two]); primary tissue failure (AVR 0.16 [one], MVR 1.0 [six], MR 1.6 [two]); anticoagulant-related hemorrhage 0.07 (one); and reoperation (AVR 0.48 [three], MVR 1.32 [eight], MR 2.4 [three]). Actuarial survival rates at 6 years, including operative deaths, are as follows: AVR 81.4% +/- 5.6%, MVR 70.0% +/- 6.7%, and MR 52.1% +/- 12.5%. The overall survival rate was 74.0% +/- 4.5% at 6 years. The freedom from all valve-related complications at 72 months was 83.9% +/- 4.8%. The freedom from valve-related death was 97.3% +/- 1.8% at 72 months. The freedom from valve-related death and reoperation at 72 months was 91.5% +/- 3.8%, and the freedom from reoperation alone was 93.4% +/- 3.5%. There were no deaths due to reoperation for primary tissue failure. Performance to date with the Carpentier-Edwards porcine bioprosthesis has been excellent, with an evaluation interval extending from 60 to 81 months.

Adolescent↗