title: Analysis of explants and causes of mortality during long-term follow-up of the Toronto stentless porcine valve.
abstract: The long-term status of stentless porcine valves has not yet been defined.
  
  
  METHODS
  447 patients were followed at 6 IDE sites up to 10 years (total follow-up, 2024.3 pt years; mean, 4.5 years): 35% were over 70 years and 41% underwent concomitant coronary artery bypass grafting.
  
  
  RESULTS
  10 patients underwent reoperation for valve explant (0.5%/pt year) because of severe aortic incompetence (AI) from dilatation of the aorta, sinotubular junction or sinus of Valsalva with torn commissures or cusps (8 patients) and endocarditis with abscess and dehiscence (2 patients). Six of 8 patients with late AI had bicuspid native aortic valves (mean age, 39.8 years). Overall freedom from reoperation was 95.2%. Freedom from structural deterioration was 96.1% at 7 years (98.0% for patients >60 years). Of 49 late deaths (2.5%/pt year), 9 were valve related (0.5%/pt year), 10 cardiac related, and 30 because of noncardiac causes. Valve-related deaths were because of endocarditis (3), CVA (1), redo surgery (1), or unknown reasons (4). Noncardiac deaths were due mainly to cancer (19/30). At seven years, freedom from all cause death was 81.8% and freedom from valve-related death 96.9%.
  
  
  CONCLUSIONS
  Late mortality after stentless valve replacement has been primarily because of comorbidities present at surgery or developing later. The Toronto stentless porcine valve is associated with a low rate of reoperation and valve-related death.
authors.affiliation: Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Y
authors.initials: Y
authors.lastname: Shargall
authors.forename: B
authors.initials: B
authors.lastname: Goldman
authors.forename: G
authors.initials: G
authors.lastname: Christakis
authors.forename: T
authors.initials: T
authors.lastname: David
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D002423:Cause of Death; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality*; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011446:Prospective Studies; D011474:Prosthesis Design; D012086:Reoperation