title: Medium to long-term clinical outcome following stentless aortic valve replacement: comparison between allograft and xenograft valves.
abstract: The xenograft stentless valve was designed to emulate the haemodynamic performance of the allograft. Early outcomes using either surgical option (stentless xenograft valve or allograft) have been similar. However, follow-up outcomes remain to be compared. Between 1st January 1991 and 1st January 2001, 415 patients underwent aortic valve replacement. Two hundred and seventeen patients received an allograft and in 198 patients a Toronto stentless porcine valve (TSPV) was implanted. Mean time to follow-up was 6.3+/-4.4 years. Ten years freedom from structural valve deterioration (SVD) (TSPV 86+/-5%, allograft 82+/-5%, P=0.49) and freedom from reoperation (RE) (TSPV 80+/-4% vs. allograft 85+/-4%, P=0.61) were not significantly different. The TSPV was associated with significantly worse actuarial survival than the homograft (TSPV 40+/-4% vs. homograft 55+/-4%, P=0.02). However, after adjustment for other variables using a multivariate model, TSPV use was not an independent predictor of impaired late survival (LS) (P=0.44). Kaplan-Meier analysis in a subgroup of patients aged 45-65 years comparing LS, RE and SVD between xenografts and allografts identified similar results. The porcine stentless valve may be associated with similar clinical performance to the allograft over the medium to long-term.
authors.affiliation: Department of Cardiothoracic Surgery, Royal Brompton Hospital, SW3 3NP, London, UK. ayyaz75@gmail.com
authors.forename: Ayyaz
authors.initials: A
authors.lastname: Ali
authors.forename: Amit
authors.initials: A
authors.lastname: Patel
authors.forename: Ziad
authors.initials: Z
authors.lastname: Ali
authors.forename: Yasir
authors.initials: Y
authors.lastname: Abu-Omar
authors.forename: Darren
authors.initials: D
authors.lastname: Freed
authors.forename: Amber
authors.initials: A
authors.lastname: Saeed
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.forename: John
authors.initials: J
authors.lastname: Pepper
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008131:London; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013552:Swine; D013997:Time Factors; D014183:Transplantation, Heterologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014463:Ultrasonography