The Half-Century Mark: Explant of Ball and Cage Valve after 50 Years

This is a case report of a 69-year-old man with chronic hemolysis and worsening diastolic heart failure, secondary to known periprosthetic leak, who underwent a reoperative mitral valve replacement 50 years following initial implantation of a Starr–Edwards ball and cage valve.

Mid-Term Comparative Follow-Up After Aortic Valve Replacement with Carpentier-Edwards and Pericarbon Pericardial Prostheses

Background —The first generation of pericardial valves had a high rate of premature deterioration. The aim of this study was to compare the outcome after aortic valve replacement with second generation pericardial prostheses (Pericarbon and Carpentier-Edwards). Methods and Results —Between 1987 and 1994, 162 patients underwent aortic valve replacement with either a Pericarbon (n=81, 69±11 years) or a Carpentier-Edwards (n=81, 70±11 years) pericardial prosthesis. Mean follow-up was 4.4±2.7 years for Pericarbon and 4.8±2.4 years for Carpentier-Edwards valves ( P =0.27), giving a total follow-up of 745 patient-years. Thirty-day mortality and 5-year actuarial survival were, respectively, 6.2% and 63.2±5.7% in the Pericarbon group and 6.2% and 63.5±5.6% in the Carpentier-Edwards group. At 8 years, freedom from (and linearized rates per patient-year) thromboembolism, structural failure, and all valve-related events were, respectively, 91.8±3.6% (1.4%), 76.9±8.7% (2.5%), and 58.4±9.3% (5.6%) in the Pericarbon group and 94.4±2.7% (1%), 100% (0%, P <0.01), and 88.8±3.7% (2%, P <0.05) in the Carpentier-Edwards group. There were 9 (11.1%) Pericarbon structural failures related predominantly to severe calcification and stenosis. The actual reoperation rate was 7.4% (1.6% per patient-year) in the Pericarbon group for fibrocalcific degeneration (n=3), periprosthetic leak (n=1), endocarditis (n=1), and aortic dissection (n=1). There was neither structural valve failure nor valve reoperation in the Carpentier-Edwards group. Echocardiographic review of 70 patients from 85 survivors (82.3%) found 4 additional Pericarbon valves with signs of early structural failure but no Carpentier-Edwards valve with such changes. Conclusions —Eight years after aortic valve replacement, Pericarbon pericardial prostheses compared unfavorably with Carpentier-Edwards pericardial prostheses, with a high incidence of structural valve failure and reoperation.