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Aortic valve replacement with a stentless porcine aortic valve. A six-year experience
T E David1, C M Feindel, J Bos
1Division of Cardiovascular Surgery, Toronto Hospital, Ontario, Canada.
Insights
Stentless porcine aortic valves demonstrate excellent outcomes for aortic valve replacement, showing improved hemodynamics and high survival rates in patients undergoing the procedure.
Area of Science:
- Cardiovascular Surgery
- Bioprosthetic Valves
- Cardiac Hemodynamics
Background:
- Aortic valve replacement is a common procedure for severe aortic stenosis.
- Bioprosthetic valves offer an alternative to mechanical valves, particularly in older patients.
- Stentless bioprostheses aim to improve hemodynamic function compared to stented valves.
Purpose of the Study:
- To evaluate the safety and efficacy of stentless porcine aortic valves for aortic valve replacement.
- To assess the hemodynamic performance and long-term outcomes of this bioprosthesis.
Main Methods:
- A cohort of 123 patients received stentless porcine aortic valves between 1987 and 1993.
- The valve was implanted in the subcoronary position using a freehand technique.
- Doppler echocardiography was used for serial hemodynamic assessment.
Main Results:
- Operative mortality was 1.6% (2 deaths).
- Actuarial survival at 6 years was 91% ± 4%.
- Significant improvements in valve hemodynamics (decreased gradients, increased effective area) were observed post-implantation, attributed to aortic root remodeling and left ventricular hypertrophy regression.
Conclusions:
- Stentless porcine aortic valves provide excellent short- and mid-term results for aortic valve replacement.
- The observed hemodynamic improvements support the use of this bioprosthesis, especially in older patient populations.
- Continued use of stentless bioprostheses is justified based on these favorable outcomes.
Abstract:
A stentless porcine aortic valve was used for aortic valve replacement in 123 patients from 1987 to 1993. The mean age of 86 men and 37 women was 61 +/- 12 years. Most patients had aortic stenosis; one-third had coronary artery disease and six had mitral valve disease. The stentless valve was secured in the subcoronary position by the same technique used for a freehand aortic valve homograft. The size of valve was based largely on the diameter of the sinotubular junction of the aortic root. The mean valve size was 26.5 mm (range 19 to 29 mm) and 87% were 25 mm or larger. Two operative deaths occurred, one the result of myocardial infarction and the other the result of infective endocarditis. Patients have been followed up from 3 to 77 months, mean 22 months. Three late deaths, none related to the valve, have occurred. The actuarial survival at 6 years was 91% +/- 4%. Four transient cerebral ischemic events have occurred, but two patients had extracranial cerebrovascular disease. One patient had endocarditis late in the postoperative period and required reoperation. All patients had Doppler echocardiographic studies before discharge from the hospital, 3 to 6 months later and annually. Only 15 patients have aortic insufficiency, trivial in 6 and mild in 9. The peak and mean systolic gradients decreased significantly during the first 3 to 6 months after implantation (p < 0.001), and the effective valve areas increased significantly during this time interval (p < 0.001). This improvement in valve hemodynamics is believed to be due to remodeling of the aortic root and regression of left ventricular hypertrophy. The results of aortic valve replacement with this stentless bioprosthesis have been excellent and justify its continued use in older patients.