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J Thorac Cardiovasc Surg 1997;113:311-318
© 1997 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

AN ANALYSIS OF VALVE RE-REPLACEMENT AFTER AORTIC VALVE REPLACEMENT WITH BIOLOGIC DEVICES

Supported by a grant from the National Heart Foundation of Australia (grant No. G90B2744).

Received for publication April 11, 1996 revisions requested June 26, 1996; revisions received August 8, 1996 accepted for publication August 12, 1996. Address for reprints: David C. McGiffin, MD, Department of Surgery, University of Alabama at Birmingham, UAB Station, Birmingham, AL 35294.

Abstract

Biologic valve re-replacement was examined in a series of 1343 patients who underwent aortic valve replacement at The Prince Charles Hospital, Brisbane, with a cryopreserved or 4° C stored allograft valve or a xenograft valve. A parametric model approach was used to simultaneously model the competing risks of death without re-replacement and re-replacement before death. One hundred eleven patients underwent a first re-replacement for a variety of reasons (69 patients with xenograft valves, 28 patients with 4° C stored allograft valves, and 14 patients with cryopreserved allograft valves). By multivariable analysis younger age at operation was associated with xenograft, 4° C stored allograft, and cryopreserved allograft valve re-replacement. However, this effect was examined in the context of longer survival of younger patients, which increases their exposure to the risk of re-replacement as compared with that in older patients whose decreased survival reduced their probability of requiring valve re-replacement. In patients older than 60 years at the time of aortic valve replacement, the probability of re-replacement (for any reason) before death was similar for xenografts and cryopreserved allograft valves but higher for 4° C stored valves. However, in patients younger than 60 years, the probability of re-replacement at any time during the remainder of the life of the patient was lower with the cryopreserved allograft valve compared with the xenograft valve and 4° C stored allografts.

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