Aortic valve replacement with Toronto SPV bioprosthesis: optimal patient survival but suboptimal valve durability

Our objective was to examine the clinical outcomes of aortic valve replacement with the Toronto SPV bioprosthesis at 12 years.

The Toronto SPV was used for aortic valve replacement in 357 patients from July 1991 to December 2004. There were 244 men and 113 women with a mean age of 65 +/- 10 years. Aortic stenosis was present in 79% of patients, coronary artery disease in 38%, and left ventricular ejection fraction less than 0.40 in 12%. Patients had an annual assessment of valve function using echocardiography. The mean duration of follow-up was 7.7 +/- 3.2 years.

There were 2 operative and 79 late deaths, of which 13 were valve related and 25 heart related. Survival at 12 years was 64% +/- 4% and similar to that of the general population matched for age and sex. Forty-nine patients had echocardiographic evidence of bioprosthetic dysfunction. The freedom from structural valve degeneration at 12 years was 69% +/- 4% for all patients, 52% +/- 8% for patients less than 65 years of age, and 85% +/- 4% for patients 65 years of age or older (P = .002). Fifty patients had redo aortic valve replacement: 45 for structural valve degeneration and 5 for endocarditis. The freedom from redo aortic valve replacement at 12 years was 69% +/- 4%. Cusp tear with consequent aortic insufficiency was the most common cause of structural valve degeneration. At the latest follow-up contact, 226 (63%) patients were alive with the Toronto SPV valve in place, and 69% were in functional class I, 24% in class II, and 7% in class III.

The Toronto SPV bioprosthesis has provided optimal patient survival and symptomatic improvement but suboptimal valve durability, particularly in patients less than 65 years of age. We now use of this valve mostly in older patients who have a small aortic annulus.