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Published on: May 21, 2017
Long-Term Results After Aortic Valve Replacement with Last-Generation Stentless Prostheses
Guglielmo Stefanelli1, Fabio Sgura2, Francesca M Menozzi3
1Department of Cardiac Surgery, Hesperia Hospital, Modena, Italy.
Insights
Third-generation stentless aortic prostheses demonstrate excellent long-term clinical and hemodynamic results, offering good durability and freedom from structural deterioration. These valves are ideal for young, active patients and those at risk of patient-prosthesis mismatch.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Medical Devices
Background:
- Severe aortic valve disease necessitates aortic valve replacement (AVR) to restore cardiac function.
- Stentless pericardial aortic prostheses represent advanced options for AVR, aiming to improve clinical outcomes.
- Evaluating the long-term performance of third-generation stentless valves is crucial for surgical decision-making.
Purpose of the Study:
- To assess the long-term clinical and hemodynamic outcomes of AVR using third-generation stentless pericardial prostheses.
- To analyze the benefits and drawbacks associated with the use of these advanced aortic valves.
- To provide evidence-based recommendations for patient selection for stentless valve implantation.
Main Methods:
- A cohort of 548 consecutive patients underwent AVR with third-generation stentless pericardial prostheses (3F® and Pericarbon Freedom™) between 2003 and 2015.
- Data collected included patient demographics, surgical details (ECC and cross-clamp times), and early/in-hospital outcomes.
- Long-term follow-up assessed survival, valve function, structural deterioration, endocarditis, reoperations, and hemodynamic performance.
Main Results:
- Early mortality was 2.55% for the entire cohort and 0.91% for isolated AVR. Median follow-up was 6.77 years.
- At 12 years, cardiac survival was 91%, and all survivors were in NYHA class I. Freedom from structural valve deterioration was 86%.
- Freedom from endocarditis and reoperation was 95% at 12 years, with a mean residual gradient of 10.3 mmHg.
Conclusions:
- Third-generation stentless pericardial valves provide excellent hemodynamics and durability with freedom from structural deterioration at 12 years.
- While implantation is slightly more demanding than stented valves, it is easily reproducible with minimal training.
- These valves are recommended for young, active patients and those with large body surface area to avoid patient-prosthesis mismatch.
Introduction:
The purpose of this study was to evaluate the long-term clinical and hemodynamic results in patients affected by severe aortic valve disease after aortic valve replacement with third-generation stentless aortic prostheses (3F® stentless equine pericardial [Medtronic plc, Minneapolis Minnesota] and Pericarbon Freedom™ stentless bovine pericardial [LivaNova plc, London, United Kingdom]) and to analyze the benefits and the drawbacks associated to their use.
Materials And Methods:
Between June, 2003 and Sept, 2015 a cohort of 548 consecutive patients affected by aortic valve disease received an aortic valve replacement using a last-generation stentless pericardial aortic prosthesis at our unit. Respectively, 322 patients received a Pericarbon Freedom™ and 226 received a 3F® aortic valve. Size ranged between 19 and 29, with prevalence of 23 and 25 devices. Mean age at operation was 71± 11 years, 57% of patients were males, the mean logistic EuroScore was 8.9 ± 7.2 and 44.2% received concomitant procedures. The mean extracorporeal circulation (ECC) time was 119.2 ± 40.6. The mean cross clamp time was 90.5' ± 21.4'. In 30 patients, the aortic prosthesis was included in a Dacron tube straight graft for a Bentall operation.
Results:
Early/in-hospital mortality was 2.55% (14 cases) for the entire cohort. In patients receiving isolated aortic valve replacement (AVR), it was 0.91% (5 cases). Follow up ranged between six months and 12 years (median follow-up time: 6.77 years). During follow up, 137 patients died of all causes (25%), of whom 32 patients died of cardiac causes (5.8%). Cardiac survival probability was 91% at 12 years. All surviving patients were in NYHA class I at last follow up. Actuarial freedom from structural valve deterioration was 86% at 12 years. Freedom from endocarditis was 95% at 12 years. Freedom from a valve-related reoperation at 12 years follow up was 95%. Mean residual transprosthetic gradient at 12 years was 10.3 ± 4.8MmHg.
Conclusions:
Last-generation stentless pericardial valves offer excellent hemodynamics and adequate durability and freedom from structural deterioration at 12 years follow up. The implantation technique of a stentless valve is a little more demanding when compared to a stented valve, but it can be easily reproduced after minimal training. Incidence of endocarditis and thromboembolic events is low and comparable to stented pericardial valves. Young and active patients, and patients with large BSA where a patient-prosthesis mismatch may be anticipated are, in our opinion, ideal candidates to receive these kinds of valves.
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