title: Clinical experience with the freedom SOLO stentless aortic valve in 277 consecutive patients.
abstract: BACKGROUND
  The Sorin Freedom SOLO (FS) bovine pericardial stentless valve prosthesis is designed for supraannular, subcoronary implantation. We report our experience and results with 277 consecutively implanted FS bioprostheses.
  
  
  METHODS
  277 patients (mean age, 74.2 ± 7.3 years; 139 (50.2%) female) underwent aortic valve replacement (AVR) with the FS stentless bioprosthesis. The hemodynamic performance was investigated with transthoracic echocardiography at discharge, 6 months later, and yearly thereafter. Follow-up was 100% complete, with an average observation time of 2.6 ± 1.7 years and a total of 697.3 patient-years.
  
  
  RESULTS
  The overall 30-day mortality was 4.3%. The mortalities for isolated AVR and combined procedures were 1.9% and 7.3%, respectively. No causes of death were valve-related. Preoperative peak (74.2 ± 23.0 mm Hg) and mean (48.6 ± 16.3 mm Hg) gradients decreased to 15.6 ± 5.4 mm Hg and 8.8 ± 3.0 mm Hg postoperatively and remained unchanged for as long as 5 years. The postoperative mean effective orifice area (EOA) for valve sizes 19, 21, 23, 25, and 27 were 1.49 ± 0.32 cm(2), 1.67 ± 0.40 cm(2), 1.92 ± 0.38 cm(2), 2.01 ± 0.42 cm(2), and 2.13 ± 0.36 cm(2), respectively. Severe prosthesis-patient mismach (PPM) was completely absent, and moderate PPM occurred in 17 patients (6.1%). In isolated AVR, 0.8% of patients with preoperative sinus rhythm required a permanent pacemaker before hospital discharge. There was 100% freedom from structural valve deterioration, 99.6 % freedom from endocarditis and reoperation, and 97.3% freedom from thromboembolism at 5 years.
  
  
  CONCLUSIONS
  The FS stentless aortic valve is safe to implant, and it shows excellent hemodynamic performance and early and midterm results. Owing to the favorable EOA, the valve appears particularly attractive for patients at risk for PPM.
authors.affiliation: Department of Cardiovascular Surgery, Hietzing Hospital, Vienna, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Thalmann
authors.affiliation: Department of Cardiovascular Surgery, Hietzing Hospital, Vienna, Austria.
authors.forename: Josef
authors.initials: J
authors.lastname: Kaiblinger
authors.affiliation: University Department of Cardiac Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria.
authors.forename: Richard
authors.initials: R
authors.lastname: Krausler
authors.affiliation: Department of Cardiovascular Surgery, Hietzing Hospital, Vienna, Austria.
authors.forename: Harald
authors.initials: H
authors.lastname: Pisarik
authors.affiliation: Department of Cardiovascular Surgery, Hietzing Hospital, Vienna, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Veit
authors.affiliation: University Department of Cardiac Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria.
authors.forename: Niuscha
authors.initials: N
authors.lastname: Taheri
authors.affiliation: Department of Cardiovascular Surgery, Hietzing Hospital, Vienna, Austria.
authors.forename: Karin
authors.initials: K
authors.lastname: Kornigg
authors.affiliation: University Department of Cardiac Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Dinges
authors.affiliation: University Department of Cardiac Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Grabenwöger
authors.affiliation: Inselspital University Hospital and University of Berne, Berne, Switzerland. Electronic address: olaf.stanger@insel.ch.
authors.forename: Olaf
authors.initials: O
authors.lastname: Stanger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D002417:Cattle; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged