Aspire Porcine Bioprosthesis: Ten Years' Experience

Background and aim of the study: Clinical results of this multicenter study of the Aspire porcine valve were reported previously at eight years; the present report provides an update of valve performance to 10 years postoperatively. Methods: A total of 749 patients (60% males; mean age 73 ± 7 years) underwent implantation with the Aspire (Tissuemed) porcine bioprosthesis between 1991 and 2002, at three institutions. Follow up was complete for 98% of the cohort. The mean follow up period was 51.6 ± 39.6 months (range: 0-181 months); total follow up was 3,159 patient-years (pt-yr). Results: There were 617 aortic valve replacements (AVR), 96 mitral valve replacements (MVR) and 32 double valve replacements. There were 62 deaths (8.3%), one of which was valve-related. The late mortality rate was 9.3% per pt-yr (1.2%/pt-yr valve-related). Actuarial freedom from complications at 10 years was: thromboembolism 76 ± 4% (2.6%/pt-yr); hemorrhage 73 ± 4% (2.8%/pt-yr); structural valve deterioration (SVD) 96 ± 2% (0.2%/pt-yr); non-structural deterioration 99 ± 1% (0.1%/pt-y); prosthetic valve endocarditis 97 ± 1% (0.3%/pt-yr); and reoperation 97 ± 1% (0.4%/pt-yr). In patients aged >70 years, the 10year actuarial freedom from SVD was 98 ± 2% for AVR and 93 ± 7% for MVR. Preoperative atrial fibrillation (AF) was a significant predictor of late mortality (p 70 years. In elderly patients the presence of AF is a significant predictor of early and late mortality and morbidity.