title: Long-term clinical and echocardiographic follow-up of the freestyle stentless aortic bioprosthesis: the Tel Aviv Medical Center experience.
abstract: BACKGROUND
  Stentless aortic bioprostheses were designed to provide improved hemodynamic performance and potentially better survival.
  
  
  OBJECTIVE
  To report the outcomes of patients after aortic valve replacement with the Freestyle stentless bioprosthesis at the Tel Aviv Medical Center followed for < or = 15 years.
  
  
  RESULTS
  Between 1997 and 2011, 268 patients underwent primary aortic valve replacement with a Freestyle bioprosthesis, 211 (79%) of them in the sub-coronary position. Mean age, Charlson comorbidity index and Euro-score were 71.0 +/- 9.2 years, 4.2 +/- 1.5 and 10.2 +/- 11 respectively, and 156 (58%) were male. Peak and mean trans-aortic gradient decreased significantly (75.0 +/- 29.1 vs. 22.8 +/- 9.6 mmHg, P < 0.0001; and 43.4 +/- 17.2 vs. 12.1 +/- 5.4 mmHg, P < 0.0001 respectively) during 3 months of follow-up. Mean overall follow-up was 4.9 +/- 3.1 years and was complete in all patients. In-hospital mortality was 4.1% (n=11) but differed significantly between the first 100 patients operated before 2006 and the last 168 patients operated after January 2006 (8 vs. 3 patients, 8.0% vs. 1.8%, P = 0.01). Overall, 5 and 10 year survival rates were 85 +/- 2.5% and 57.2 +/- 5.7%, respectively. Five year survival was markedly improved in patients operated after January 2006 compared to those operated in the early years of the experience (92.3 +/- 2.3% vs. 76.0 +/- 4.4%, P = 0.0009). All the 21 octogenarians operated after January 2006 survived surgery, with excellent 5 year survival (85.1 +/- 7.9%). Six patients required reoperation during follow-up: structural valve deterioration in five and endocarditis in one.
  
  
  CONCLUSIONS
  Aortic valve replacement with the Freestyle bioprosthesis provides good long-term hemodynamic and clinical outcomes, even in octogenarians. Valve calcification is the major (and rare) mode of valve deterioration leading to reoperation in these patients.
authors: Division of Cardiovascular Diseases, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel.
authors: Arie Lorin
authors: AL
authors: Schwartz
authors: Division of Cardiovascular Diseases Sourasky Tel Aviv Medical Center, Tel Aviv, Israel.
authors: Yan
authors: Y
authors: Topilsky
authors: Division of Cardiovascular Surgery, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel.
authors: Gideon
authors: G
authors: Uretzky
authors: Division of Cardiovascular Surgery, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel.
authors: Nahum
authors: N
authors: Nesher
authors: Division of Cardiovascular Surgery, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel.
authors: Yanai
authors: Y
authors: Ben-Gal
authors: Division of Cardiovascular Diseases Sourasky Tel Aviv Medical Center, Tel Aviv, Israel.
authors: Simon
authors: S
authors: Biner
authors: Division of Cardiovascular Diseases Sourasky Tel Aviv Medical Center, Tel Aviv, Israel.
authors: Gad
authors: G
authors: Keren
authors: Division of Cardiovascular Surgery, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel.
authors: Amir
authors: A
authors: Kramer
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D002114:Calcinosis / Q000453:epidemiology; D019560:Echocardiography, Three-Dimensional; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome