title: The Freedom Solo pericardial stentless valve: Single-center experience, outcomes, and long-term durability.
abstract: OBJECTIVE
  To report our institutional experience and long-term results with the Freedom Solo bovine pericardial stentless bioprosthesis (Sorin Group, Saluggia, Italy).
  
  
  METHODS
  Between January 2005 and November 2009, 149 patients (mean age, 73.6 ± 8.7 years; 68 [45.6%] female) underwent isolated (n = 75) or combined (n = 74) aortic valve replacement (AVR) using the Solo in our institution. Follow-up was 100% complete with an average follow-up time of 5.9 ± 2.6 years (maximum, 9.6 years) and a total of 885.3 patient years.
  
  
  RESULTS
  Operative (30-day) mortality was 2.7% (1.3% for isolated AVR [n = 1] and 4.0% for combined procedures [n = 3]). All causes of death were not valve-related. Preoperative peak (mean) gradients of 74.2 ± 23.0 mm Hg (48.6 ± 16.3 mm Hg) decreased to 15.6 ± 5.4 mm Hg (8.8 ± 3.0 mm Hg) after AVR, and remained low for up to 9 years. The postoperative effective orifice area was 1.6 ± 0.57 cm(2), 1.90 ± 0.45 cm(2), 2.12 ± 0.48 cm(2), and 2.20 ± 0.66 cm(2) for the valve sizes 21, 23, 25, and 27, respectively, with absence of severe prosthesis-patient mismatch and 0.7% (n = 1) experienced moderate prosthesis-patient mismatch. During follow-up, 26 patients experienced structural valve deterioration (SVD) and 14 patients underwent explantation. Kaplan-Meier estimates for freedom from death, explantation, and SVD at 9 years averaged 0.57 (range, 0.47-0.66), 0.82 (range, 0.69-0.90), and 0.70 (range, 0.57-0.79), respectively.
  
  
  CONCLUSIONS
  The Freedom Solo stentless aortic valve is safe to implant and shows excellent early and midterm hemodynamic performance. However, SVD was observed in a substantial number of patients after only 5-6 years and the need for explantation increased markedly, suggesting low durability.
authors.affiliation: Clinic for Cardiovascular Surgery, Inselspital University Hospital Bern, Bern, Switzerland. Electronic address: oh.stanger@gmail.com.
authors.forename: Olaf
authors.initials: O
authors.lastname: Stanger
authors.affiliation: Clinic for Cardiovascular Surgery, Inselspital University Hospital Bern, Bern, Switzerland.
authors.forename: Irina
authors.initials: I
authors.lastname: Bleuel
authors.affiliation: Clinic for Cardiovascular Surgery, Inselspital University Hospital Bern, Bern, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Gisler
authors.affiliation: Clinic for Cardiovascular Surgery, Inselspital University Hospital Bern, Bern, Switzerland.
authors.forename: Volkhard
authors.initials: V
authors.lastname: Göber
authors.affiliation: Clinic for Cardiovascular Surgery, Inselspital University Hospital Bern, Bern, Switzerland.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Reineke
authors.affiliation: Clinic for Cardiovascular Surgery, Inselspital University Hospital Bern, Bern, Switzerland.
authors.forename: Brigitta
authors.initials: B
authors.lastname: Gahl
authors.affiliation: Clinic for Cardiovascular Surgery, Inselspital University Hospital Bern, Bern, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Aymard
authors.affiliation: Clinic for Cardiovascular Surgery, Inselspital University Hospital Bern, Bern, Switzerland.
authors.forename: Lars
authors.initials: L
authors.lastname: Englberger
authors.affiliation: Clinic for Cardiovascular Surgery, Inselspital University Hospital Bern, Bern, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.affiliation: Clinic for Cardiovascular Surgery, Inselspital University Hospital Bern, Bern, Switzerland.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Tevaearai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis; D018572:Disease-Free Survival; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium; D011474:Prosthesis Design; D015607:Stents; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: aortic valve; bioprosthesis; cardiac surgery; stentless; valve surgery