title: Which biologic valve should we select for the 45- to 65-year-old age group requiring aortic valve replacement?
abstract: OBJECTIVE
  The diversity of biologic valves available to replace the aortic valve renders selection difficult for the 45- to 65-year-old patient. To evaluate and compare the results of biologic valves in the 45- to 65-year-old patient, we reviewed our experience (1991-2004).
  
  
  METHODS
  Three hundred thirty-two patients between 45 and 65 years old with isolated aortic valve disease had a biologic valve implanted: Freestyle valve in 140 patients, a homograft in 54 patients, a stented Mosaic or Perimount valve (stented xenograft) in 62 patients, and a Ross procedure in 76 patients.
  
  
  RESULTS
  Perioperative mortality was comparable for all groups (Freestyle, 2.1%; homograft, 3.7%; stented xenograft, 3.2%; Ross procedure, 1.3%; P = .8). Echocardiographically determined valve performance at discharge was significantly enhanced in the Ross procedure and homograft groups (indexed effective orifice area: Freestyle, 0.9 +/- 0.3 cm 2 /m 2 ; homograft, 1.3 +/- 0.3 cm 2 /m 2 ; stented xenograft, 0.8 +/- 0.2 cm 2 /m 2 ; Ross procedure, 1.4 +/- 0.4; P < .0001; mean gradient: Freestyle, 12.0 +/- 6.6 mm Hg; homograft, 7.4 +/- 4.0 mm Hg; stented xenograft, 15.4 +/- 5.4 mm Hg; Ross procedure, 4.6 +/- 3.2 mm Hg; P < .0001). For all yearly follow-up, freedom from New York Heart Association class III or IV was comparable and greater than 95% for all groups. At 7 years, cardiac survival (homograft, 96.3% +/- 3.7%; Ross procedure, 90.6% +/- 6.3%; stented xenograft, 86.0% +/- 10.3%; Freestyle, 89.2% +/- 10.8%; P = .7) and freedom from reoperation (Ross procedure, 98.5% +/- 1.4%; homograft, 90.6% +/- 5.7%; Freestyle, 88.0% +/- 4.9%; stented xenograft, 90.0% +/- 8.0%; P = .4) were comparable. Freedoms from significant bleeding events, valve-related neurologic events, or endocarditis were comparable and greater than 95% for all groups.
  
  
  CONCLUSIONS
  Type of aortic biologic valve for the 45- to 65-year-old patient does not affect midterm survival or valve-related morbidity. Thus the choice of biologic valve for the 45- to 65-year-old patient should be dictated by patient-surgeon preference, ease of implantation, and reoperation until longer comparative studies are available.
authors.affiliation: Department of Cardiac Surgery, Laval Hospital, 2725 chemin Sainte-Foy, Sainte-Foy, Quebec, Canada G1V 4G5. francois.dagenais@chg.ulaval.ca
authors.forename: F
authors.initials: F
authors.lastname: Dagenais
authors.forename: P
authors.initials: P
authors.lastname: Cartier
authors.forename: P
authors.initials: P
authors.lastname: Voisine
authors.forename: D
authors.initials: D
authors.lastname: Desaulniers
authors.forename: J
authors.initials: J
authors.lastname: Perron
authors.forename: R
authors.initials: R
authors.lastname: Baillot
authors.forename: G
authors.initials: G
authors.lastname: Raymond
authors.forename: J
authors.initials: J
authors.lastname: Métras
authors.forename: D
authors.initials: D
authors.lastname: Doyle
authors.forename: P
authors.initials: P
authors.lastname: Mathieu
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001705:Bioprosthesis / Q000009:adverse effects / Q000592:standards* / Q000600:supply & distribution; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000592:standards* / Q000600:supply & distribution; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D018579:Patient Selection; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012086:Reoperation / Q000706:statistics & numerical data; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D014183:Transplantation, Heterologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014463:Ultrasonography