title: Stentless aortic xenograft valve replacement: lessons learned after 300 implants.
abstract: Early results after aortic valve replacement (AVR) with three different types of stentless xenografts suggested less satisfactory outcome with a simplified implant model (Cryolife-O'Brien) compared with two standard implant models (Biocor PSB, Toronto SPV). To assess the impact of experience on mid-term outcome after stentless AVR, results with 322 implants were reviewed. Between July 1992 and February 1999, 106 patients underwent operations to implant the Biocor PSB (group 1), 139 patients the Toronto SPV (group 2), and 77 patients the Cryolife-O'Brien valve (group 3). Mean age (70+/-6 years; 70+/-7 years; 71+/-7 years; P = .7), prevalence of male gender (56 patients, 53%; 72 patients, 55%; 38 patients, 49%; P = .4), prevalence of aortic stenosis (72 patients, 68%; 77 patients, 55%; 38 patients, 49%; P = .7), and need for associated procedures (51 patients, 48%; 54 patients, 39%; 33 patients, 43%; P = .7) were similar among all three groups, respectively. Mean aortic cross-clamp time was shorter in group 3 (96+/-24 min; 98+/-24 min; 78+/-22 min; P = .02). Early deaths (3/106, 3%; 4/139, 3%; 2/77; 3%, P = .8) and late survival were comparable (89%+/-5%, 93%+/-4%, and 85%+/-7% at 5 years, P = .1) among groups. Follow-up ranged from 1 to 84 months (mean 52+/-20 months). Five-year freedom from valve deterioration (95%+/-5%, 96%+/-3%, and 85%+/-7%, P = .008) and from reoperation (98%+/-2%, 98%+/-2%, 92%+/-4%, P = .01) was significantly poorer in group 3 patients. When valve failure resulting from technical mishaps (none in the last 60 implants) with the Cryolife-O'Brien valve was excluded, no significant difference in freedom from valve deterioration was noted (98%+/-2%, 96%+/-3%, and 95%+/-4%, P = .1). Late functional status of 290 survivors was satisfactory and comparable among groups (1.3+/-0.8, 1.1+/-0.4, and 1.4+/-0.7 New York Heart Association class, P = .5). After an initial learning curve, simplified implant stentless xenografts offer satisfactory mid-term results, which are comparable to two-suture-line implant valves. Owing to the shorter grafting time, simplified implant xenografts such as the Cryolife-O'Brien may be particularly suited for complex operations where associated procedures are required.
authors.affiliation: Division of Cardiac Surgery, University of Verona, Italy.
authors.forename: G B
authors.initials: GB
authors.lastname: Luciani
authors.forename: P
authors.initials: P
authors.lastname: Bertolini
authors.forename: B
authors.initials: B
authors.lastname: Vecchi
authors.forename: L
authors.initials: L
authors.lastname: Barozzi
authors.forename: G
authors.initials: G
authors.lastname: Casali
authors.forename: A
authors.initials: A
authors.lastname: Mazzucco
mesh_terms: D000368:Aged; D001021:Aortic Valve; D001705:Bioprosthesis; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome