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When Not to Go SOLO? Contraindications Based on Implant Experience.
Laurens W Wollersheim1, Wilson W Li2, Abdullah Kaya2
1Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic correspondence: l.w.wollersheim@amc.nl.
The Journal of Heart Valve Disease
|March 15, 2017
Summary
Patient selection is key for the stentless Freedom SOLO bioprosthesis. Contraindications like asymmetric commissures and large aortic annulus ensure excellent durability, avoiding reoperations for aortic valve insufficiency or leakage.
Area of Science:
- Cardiac Surgery
- Bioprosthetic Valves
- Aortic Valve Replacement
Background:
- The stentless Freedom SOLO bioprosthesis requires careful patient selection due to its design and implantation technique.
- Understanding contraindications is crucial for successful outcomes.
Purpose of the Study:
- To identify and discuss contraindications for the Freedom SOLO bioprosthesis.
- To share insights from extensive implant experience.
Main Methods:
- A retrospective review of 292 aortic valve replacements performed between April 2005 and February 2015.
- Data collection on the use of SOLO valves versus stented bioprostheses.
Main Results:
- A SOLO valve was implanted in 82% (238) of patients; a stented bioprosthesis in 18% (54).
- Primary reasons for not using SOLO included asymmetric commissures (26%) and large aortic annulus (24%).
- Low rates of structural valve deterioration (1 patient) and no reoperations for insufficiency or leakage were observed.
Conclusions:
- Contraindications include asymmetric commissures, large aortic annulus (>27 mm), calcified sinuses, dilated sinotubular junction, and aberrant coronary ostia.
- Adhering to these contraindications leads to very good mid-term durability with the SOLO valve.
