title: The impact of new technology on a clinical practice.
abstract: The use of xenograft stentless tissue valves has increased because of excellent hemodynamics and availability. This article describes the impact of the incorporation of this new technology into a single institutional practice over time. A time span for continual usage of the new stentless Freestyle valve was divided into four distinct chronological groups and evaluated. Data on 266 consecutive patients receiving the Freestyle prosthesis were analyzed with regard to demographics, degree of illness, complexity of surgery, and outcomes to discover any distinct changes over time with respect to experience and acquired confidence and surgical expertise. Findings among the four groups were compared using Student's t-test. The only change in patient demographics was younger age (mean age decreased from 70 to 62 years). The number of procedures rose steadily, and the degree of illness increased as noted in the increase between groups in the percentage of patients with comorbidities (from 45% to 92%). The complexity of surgery score steadily increased (from 1.9 to 2.5); however, the mean cross-clamp time did not change. The surgical mortality rate for the entire study was 3.4%. In group 1, the mortality was 7.5% but decreased rapidly and remained steady throughout the rest of the study. The use of the Freestyle stentless conduit in a single practice over time shows a distinct learning curve. With experience, valves are placed in younger, sicker patients who require more complex surgery. Surgical outcomes and efficiency improve with acquired surgical expertise.
authors.affiliation: Section of Cardiac Surgery, The University of Michigan, Ann Arbor 48109-0348, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Sonnad
authors.forename: D S
authors.initials: DS
authors.lastname: Bach
authors.forename: S F
authors.initials: SF
authors.lastname: Bolling
authors.forename: W F
authors.initials: WF
authors.lastname: Armstrong
authors.forename: F D
authors.initials: FD
authors.lastname: Pagani
authors.forename: M J
authors.initials: MJ
authors.lastname: Shea
authors.forename: H M
authors.initials: HM
authors.lastname: Monaghan
authors.forename: G M
authors.initials: GM
authors.lastname: Deeb
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D013997:Time Factors; D016896:Treatment Outcome