Clinical use of stentless aortic valves with standard and minimally invasive surgical techniques

The stentless porcine aortic valve prostheses have the potential to provide superior hemodynamic function and durability. Our institution was a trial site for the investigational device exemption (IDE) for 2 of the 3 stentless valve bioprostheses and has clinical experience in all 3 valves that are soon to be available. From July 1996 to January 2001, we have implanted 213 porcine stentless valves: the Toronto SPV (159), the Freestyle (20), and the Prima Plus (34) (current IDE). Fifty-five percent of these patients had concomitant coronary artery bypass graft procedures, 44% had isolated aortic valve replacements, and 3 patients required aortic valve and mitral valve procedures. Fifty-nine percent of the patients were men, 9% of procedures were reoperations, and 22% of patients were in New York Heart Association classification III or IV preoperatively. Extubation occurred within 5 hours for 52% of patients, median cardiothoracic intensive care unit length of stay was 1 day, and postoperative length of stay was 6 days. Reoperations for bleeding occurred in 5.3% of patients (0 in the past 12 months), atrial fibrillation in 28.2%, and permanent neurologic deficit in 1.9%. No patients required valve-related reoperations or had either sepsis or sternal infections. Operative mortality was 1.4%. We have also analyzed a subset of patients who had minimally invasive aortic valve replacement versus the standard approach and found no important differences in mortality (none), postoperative complications, cardiopulmonary bypass, or cross-clamp times. There was a trend towards earlier ambulation, less atrial fibrillation (15.8% v 24.1%), and earlier hospital discharge (5.6 days v 7.2 days). We conclude that excellent results were obtained with all 3 stentless aortic valve bioprostheses. Hospital events should be predictably low in elderly patients and those requiring concomitant procedures. Stentless aortic valve bioprostheses can be incorporated into regular cardiac surgical practice with the techniques described.