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Stentless aortic xenograft valve replacement: lessons learned after 300 implants
G B Luciani1, P Bertolini, B Vecchi
1Division of Cardiac Surgery, University of Verona, Italy.
Seminars in Thoracic and Cardiovascular Surgery
|February 5, 2000
Summary
Mid-term outcomes for stentless aortic valve replacement (AVR) show that simplified implant valves, like the Cryolife-O'Brien, achieve results comparable to standard models after an initial learning curve.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
Background:
- Stentless xenografts for aortic valve replacement (AVR) have varying early outcomes.
- The Cryolife-O'Brien simplified implant model showed less satisfactory early results compared to standard models.
Purpose of the Study:
- To evaluate the mid-term outcomes of stentless AVR using three different xenograft types.
- To assess the impact of surgical experience on outcomes with stentless aortic valves.
Main Methods:
- A retrospective review of 322 stentless aortic valve replacements between July 1992 and February 1999.
- Comparison of outcomes between Biocor PSB (n=106), Toronto SPV (n=139), and Cryolife-O'Brien (n=77) valve groups.
- Analysis of early mortality, late survival, valve deterioration, reoperation rates, and functional status.
Main Results:
- Early mortality and 5-year survival rates were comparable across all three valve types.
- Five-year freedom from valve deterioration and reoperation was poorer for the Cryolife-O'Brien valve initially.
- Excluding technical mishaps, freedom from valve deterioration was similar, suggesting a learning curve for the simplified implant.
- Late functional status was satisfactory and comparable among groups.
Conclusions:
- Simplified implant stentless xenografts, after an initial learning curve, provide satisfactory mid-term results comparable to standard two-suture-line valves.
- The shorter implantation time of simplified valves may benefit complex procedures requiring associated surgeries.