title: Early experience with the Toronto stentless porcine valve.
abstract: Stentless porcine valves in the aortic position offer many theoretic advantages, but their clinical performance has not been adequately defined. We evaluated the clinical and echocardiographic results of 103 patients who had aortic valve replacement with the Toronto stentless porcine valve over a 2-year period. There were 67 men with a mean age of 68 years. The predominant native valve lesion was aortic stenosis (64%), and 4 patients had prosthetic valve dysfunction. Forty-two patients had concomitant procedures. The 30-day mortality rate was 3.3% (n = 2) for isolated valve replacement and 5.8% (n = 6) for the series. The sole determinant of early death was poor left ventricular function. There were three late deaths due to non-valve-related complications over a median follow-up of 11.87 months. In addition, prosthetic valve endocarditis developed in 1 patient, necessitating a homograft valve replacement at 6 weeks. Doppler echocardiography performed at 3 to 6 months showed low peak and mean transvalvular gradients, with no substantial change at 1 year. None of the patients showed signs of clinically significant aortic regurgitation, although echocardiography demonstrated trivial or mild regurgitation in 12 patients at discharge or early follow-up, which was less marked or absent at 1 year. We conclude that the Toronto stentless porcine valve appears to offer promising early results.
authors.affiliation: Royal Brompton Hospital, London, England.
authors.forename: K
authors.initials: K
authors.lastname: Wong
authors.forename: S
authors.initials: S
authors.lastname: Shad
authors.forename: P D
authors.initials: PD
authors.lastname: Waterworth
authors.forename: A
authors.initials: A
authors.lastname: Khaghani
authors.forename: J R
authors.initials: JR
authors.lastname: Pepper
authors.forename: M H
authors.initials: MH
authors.lastname: Yacoub
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D001705:Bioprosthesis / Q000009:adverse effects / Q000401:mortality; D018618:Echocardiography, Doppler, Color; D004696:Endocarditis / Q000209:etiology; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011475:Prosthesis Failure; D015996:Survival Rate; D013923:Thromboembolism / Q000209:etiology; D016277:Ventricular Function, Left