Asynchronous primary valve failure in patients with porcine bioprosthetic aortic and mitral valves.

Seventy-three patients with aortic and mitral porcine bioprosthetic valves (PBV) have been followed for up to 14 1/2 years. In that time, 11 patients have undergone replacement of one or more PBVs for primary tissue failure. Three patients underwent repeat aortic and mitral valve replacement for synchronous PBV failure. Two patients underwent aortic valve replacement alone and six had only the mitral PBV replaced. The one survivor of the repeat aortic valve replacement has a normally functioning mitral PBV, which has now been in place for 48 months. The six patients who had their mitral PBVs replaced have normally functioning aortic PBVs that have now been in place for periods from 96 to 176 months. Our experience shows that with asynchronous PBV failure only the dysfunctioning valve needs to be replaced. Prophylactic PBV replacement is not warranted if the prosthesis demonstrates normal hemodynamics on cardiac catheterization and normal structure on the echocardiogram, regardless of the length of time it has been implanted.