title: Limited long-term durability of the Cryolife O'Brien stentless porcine xenograft valve.
abstract: BACKGROUND
  Despite the fact that early and midterm hemodynamic and clinical results of the Cryolife O'Brien (CLOB) stentless valve have been reported to be favorable, the long-term durability and clinical results of this valve are largely unknown. Accordingly, we analyzed 10-year outcomes after aortic valve replacement with this valve.
  
  
  RESULTS
  From January 1994 to September 2004, 185 patients (67, 73, and 75 years, 25th, 50th, and 75th quartiles, respectively; 38% older than 75 years; 56% females) underwent aortic valve replacement with the CLOB valve. Sixty-eight percent of patients were in NYHA class 3 to 4. Standard EuroSCORE was 7.1+/-2.7. Pure aortic stenosis accounted for 42% (n=79), and pure insufficiency for 12% of cases (n=22). Concomitant surgery: 28% coronary artery bypass (n=51), 11% mitral valve replacement/annuloplasty (n=21), and 2% ascending aorta replacement (n=3). Sixty-one percent of patients received a 23-mm valve or smaller size. Follow-up was 100% completed, and cumulative follow-up was 65 months/patient. The 30-day mortality was 5.4% (none were valve related). Actuarial survival at 5 and 10 years were 68% and 40%, respectively. Actuarial freedom from structural valve deterioration was 91% at 5 years and dropped to 44% at 10 years. Actuarial freedom from reoperation was 94% at 5 years and declined to 57% at 10 years.
  
  
  CONCLUSIONS
  In a population with a high prevalence of elderly females with small aortic root, the CLOB valve demonstrated satisfactory clinical results till 8-years. Afterward, a significant increase in hazard for structural valve deterioration and reoperation occurred in late follow-up.
authors.affiliation: Department of Cardiopulmonary Sciences, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, P.le S Maria della Misericordia 15, 33100 Udine, Italy. daisy_pav@libero.it
authors.forename: Daisy
authors.initials: D
authors.lastname: Pavoni
authors.forename: Luigi P
authors.initials: LP
authors.lastname: Badano
authors.forename: Fabio
authors.initials: F
authors.lastname: Ius
authors.forename: Enzo
authors.initials: E
authors.lastname: Mazzaro
authors.forename: Romeo
authors.initials: R
authors.lastname: Frassani
authors.forename: Sandro
authors.initials: S
authors.lastname: Gelsomino
authors.forename: Ugolino
authors.initials: U
authors.lastname: Livi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001705:Bioprosthesis / Q000592:standards* / Q000639:trends*; D005260:Female; D006350:Heart Valve Prosthesis / Q000592:standards* / Q000639:trends*; D006801:Humans; D008297:Male; D015996:Survival Rate / Q000639:trends; D013552:Swine; D013995:Time; D016896:Treatment Outcome