Stentless freestyle aortic valve/root bioprostheses: a northern Ontario community hospital perspective.
OBJECTIVE
To examine the controversial issues of postoperative aortic insufficiency (AI), operative mortality and length of hospital stay (LOS) following stentless Freestyle aortic valve replacement (AVR).


METHODS
All surgeries were performed in a small northern community hospital (Sudbury Regional Hospital, Sudbury, Ontario).


METHODS
Retrospective study of all stentless AVRs and all stented AVRs from May 1996 to December 1998, and isolated coronary artey bypasses (CABGs) done in 1996/97.


METHODS
Patients were not selected. All consecutive patients requiring bioprosthetic AVR during this period, regardless of risk, complexity or urgency, were included. In total, 112 stentless AVRs, 138 stented AVRs and 432 isolated CABGs were examined.


RESULTS
AI was rare following stentless AVRs: no significant valvular AI and only 0.9% significant paravalvular AI occurred. The incidence of AI was significantly greater with continuous than with interrupted proximal suturing (P=0. 016). No valve thromboses, thromboemboli or structural failure occurred during 3.8 years of follow-up of the stentless AVRs. The LOS for stentless AVRs was no longer than for stented AVRs or for isolated CABGs. No significant difference was found in the operative mortality following stentless and stented AVRs. The early mortality rate of 1.8% for stentless AVRs was not affected by preoperative risk strata, complexity or urgency.


CONCLUSIONS
Early morbidity with stentless AVRs was comparable and LOS was no longer than with stented AVRs. The use of Freestyle bioprosthesis in itself did not result in greater operative mortality, regardless of risk, complexity or urgency of the procedure. Consistent reproducible techniques and experience improve postoperative outcome. It is essential that potential users carefully learn safe and effective surgical techniques to avoid adverse outcomes during the learning curve.
Mathur
A N
AN
Sudbury Regional Hospital and Laurentian University, Canada. amathur@hrsrh.on.ca
Hourtovenko
C D
CD
Baigrie
R S
RS
Mecci
S U
SU
Ravi
G D
GD
Garg
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D020099:Coated Materials, Biocompatible; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011183:Postoperative Complications; D011474:Prosthesis Design; D012189:Retrospective Studies; D013193:Stainless Steel
D020099:Coated Materials, Biocompatible; D013193:Stainless Steel