The St. Jude Toronto stentless bioprosthesis: up to 20 years follow-up in younger patients.
BACKGROUND
A retrospective long-term evaluation of the St. Jude Toronto stentless bioprosthesis in patients aged 60 years or younger.


METHODS
From 1994 to 1997, 50 patients underwent aortic valve replacement with the prosthesis. Patients mean age at surgery was 54.5±6.3 years. Follow-up data were acquired by patient file research and telephone interviews. Morbidity and mortality were evaluated with time-to-event analyses using the Kaplan-Meier-method. The log-rank test was used to determine influencing factors for long-term survival and reoperation.


RESULTS
Mean follow-up was 13.5±6.3 years with a total follow-up of 661.8 patient-years and a maximum of 20.0 years. Follow-up was 97.8% complete. Associated procedures were performed in 12 patients (24%), including coronary artery bypass grafting, mitral valve replacement and replacement of the ascending aorta. Freedom from reoperation at 10 and 15 years was 76.0±6.7% and 44.1±8.9%, respectively. Reoperations (n=26) started 4.4 years after implantation and were necessary due to: valve degeneration with regurgitation in 79.2% and stenosis in 12.5%, endocarditis in 4.2% and sinus valsalva aneurysm in 4.2% of the cases. The log-rank test revealed that only body-mass-index&gt;25 lowered freedom-from-reoperation, while renal dysfunction, diabetes mellitus and arterial hypertension were not. Overall long-term survival at 10 and 20 years was 82.3±5.7% and 49.9±8.9%, respectively.


CONCLUSIONS
In younger patients the Toronto-bioprosthesis provided reliable long-term survival despite limited durability.
Charité-Universitätsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany.
Torsten
T
Christ
Charité-Universitätsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany.
Benjamin
B
Claus
Charité-Universitätsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany.
Robin
R
Borck
Charité-Universitätsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany.
Wolfgang
W
Konertz
Charité-Universitätsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany.
Herko
H
Grubitzsch
D000328:Adult; D017677:Age Distribution; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D001705:Bioprosthesis / Q000706:statistics & numerical data*; D019544:Equipment Failure Analysis; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D015995:Prevalence; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome