title: Long-term results after aortic valve replacement with the Bravo 400 stentless xenograft.
abstract: BACKGROUND
  This study was undertaken to evaluate the long-term clinical and echocardiographic outcome after aortic valve replacement with the Bravo Cardiovascular Model 400 stentless xenograft.
  
  
  METHODS
  Between February 1992 and January 1994, 67 patients underwent aortic valve replacement with the Bravo 400 bioprosthesis. The valvular pathology was aortic stenosis in 36 patients (53.7%), aortic insufficiency in 17 patients (25.4%), and mixed lesion in 14 patients (20.9%). Mean follow-up time was 9.8 +/- 2.73 years and median follow-up time was 11 years. Cumulative follow-up time was 659 patients-years and was 94% complete.
  
  
  RESULTS
  No early deaths were observed. Overall survival estimates at 11 years were 74.71% +/- 5.47%. The actuarial freedom from valve-related death at 11 years was 91.04% +/- 3.84%; from cardiac-related death at 11 years it was 87.95% +/- 4.29%; and from noncardiac death at 11 years it was 85.14% +/- 4.58%. Eleven-year Kaplan-Meier survival of patients younger than 65 years was 90.91% +/- 6.13% versus 66.08% +/- 7.38% for older patients (p = 0.0307, log-rank test). The actuarial freedom from all valve-related morbidity and mortality at 11 years was 80.3% +/- 5.4%. The mean transvalvular gradient decreased significantly after aortic valve replacement with a corresponding increase in effective orifice area. Left ventricular mass index at 10-year follow-up was 68.5% of the preoperative value.
  
  
  CONCLUSIONS
  The Bravo Cardiovascular Model 400 stentless xenograft has provided good clinical and hemodynamic results up until 11 years of follow-up.
authors.affiliation: Department of Cardiac Surgery and Cardiology, University of Milan, Centro Cardiologico Monzino IRCCS, Milan, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Polvani
authors.forename: Fabio
authors.initials: F
authors.lastname: Barili
authors.forename: Luca
authors.initials: L
authors.lastname: Dainese
authors.forename: Manuela
authors.initials: M
authors.lastname: Muratori
authors.forename: Massimo
authors.initials: M
authors.lastname: Porqueddu
authors.forename: Andrea
authors.initials: A
authors.lastname: Sala
authors.forename: Paolo
authors.initials: P
authors.lastname: Biglioli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis