Long-Term Results After Aortic Valve Replacement with Last-Generation Stentless Prostheses

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.