title: Eight-year results after aortic valve replacement with the CryoLife-O'Brien Stentless Aortic Porcine Bioprosthesis.
abstract: OBJECTIVE
  The long-term durability and hemodynamics of stentless valves are largely unknown. In this study we prospectively analyzed 8-year clinical results with the CryoLife-O'Brien Stentless Aortic Porcine Bioprosthesis (CryoLife Inc, Kennesaw, Ga) and assessed its hemodynamic performance by serial echocardiography.
  
  
  METHODS
  A total of 206 patients with a mean age of 72.8 years were followed up prospectively after aortic valve replacement with the CryoLife-O'Brien stentless bioprosthesis. Patients have been followed up from 2 to 96 months for mean 56 months. Echocardiography was performed by a single echocardiographer preoperatively, intraoperatively, postoperatively at discharge, 3 to 6 months later, and annually thereafter.
  
  
  RESULTS
  The 30-day operative mortality was 4.8%. Sixty-five percent of patients received a valve 25 mm in diameter or larger, and 37% underwent concomitant coronary bypass grafting. Twelve late deaths, none valve-related, have occurred. Severe aortic insufficiency caused by oversizing led to early reoperation in 3 patients. The peak and mean systolic gradients decreased significantly during the first 12 months after implantation (P < .001), and the effective valve areas increased significantly during this interval (P < .001). At 8 years, 2 patients have mild to moderate aortic insufficiency. The actuarial survival at 8 years was 82% +/- 3%. The freedom from endocarditis was 100%, and the freedom from thromboembolic events was 93%.
  
  
  CONCLUSIONS
  Despite more demanding surgical technique than with conventional bioprostheses, the CryoLife-O'Brien bioprosthesis can be implanted safely in a population predominantly older than 70 years at the time of the operation, with excellent measures of hemodynamics, clinical outcomes, prosthesis durability, and survival through 8 years.
authors.affiliation: Department of Cardiothoracic Surgery, Klinikum Krefeld, Krefeld, Germany. martinov@med.uni-marburg.de
authors.forename: Ivo
authors.initials: I
authors.lastname: Martinovic
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Farah
authors.forename: Manfred
authors.initials: M
authors.lastname: Everlien
authors.forename: Stephan
authors.initials: S
authors.lastname: Lindemann
authors.forename: Igor
authors.initials: I
authors.lastname: Knez
authors.forename: Thomas
authors.initials: T
authors.lastname: Wittlinger
authors.forename: Hans
authors.initials: H
authors.lastname: Greve
authors.forename: Paul
authors.initials: P
authors.lastname: Vogt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery; D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012086:Reoperation