title: Fate of aortic bioprostheses: An 18-year experience.
abstract: OBJECTIVE
  To report our experience in aortic valve replacement with the Mitroflow (Sorin, Vancouver, Canada) aortic bioprosthesis.
  
  
  METHODS
  We retrospectively reviewed all patients who underwent aortic valve replacement with a Mitroflow bioprosthesis at our institution from January 1994 to December 2011. No exclusion criteria were retained. Patients were followed yearly. Echocardiography follow-up was performed systematically before the hospital discharge and annually by patients' cardiologists.
  
  
  RESULTS
  Seven hundred twenty-eight patients (mean age, 76 ± 6 years; range, 33-91 years) underwent aortic valve replacement with Mitroflow 12A or LX model and were included in this analysis. 30-day mortality for nonemergent isolated aortic valve replacement was 5.5%. Eight patients (1%) underwent reoperation for structural valve deterioration (SVD) and 30 patients (5.8%) presented echocardiographic signs of SVD. Actuarial freedom from reoperation for SVD was 99% ± 0.5% and 95% ± 5% at 10 and 15 years. Actuarial freedom from echocardiographic signs of SVD was 77% ± 5% and 56% ± 11% at 10 and 15 years, respectively. At the univariate analysis, only the mean gradient at discharge (P = .0200), the prevalence of size 19 (P = .0273), and severe patient-prosthesis mismatch (P = .0384) were significantly different in patients developing SVD at follow-up. Freedom from echocardiographic signs of SVD at 8 years were 88% ± 4% and 64% ± 13% in patients with a Mitroflow > 19 and Mitroflow 19, respectively (log-rank test, P = .0056; Wilcoxon test, P = .0589).
  
  
  CONCLUSIONS
  Overall outcomes were satisfactory. However the risk of early SVD seems higher for the Mitroflow size 19. This size should be reserved for applications when annulus enlargement is risky or there is an anatomic contraindication to sutureless or stentless valve.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, "Dupuytren" University Hospital, Limoges, France. Electronic address: alessandropiccardo@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Piccardo
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, "Dupuytren" University Hospital, Limoges, France.
authors.forename: Jean David
authors.initials: JD
authors.lastname: Blossier
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, "Dupuytren" University Hospital, Limoges, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Le Guyader
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, "Dupuytren" University Hospital, Limoges, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Orsel
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, "Dupuytren" University Hospital, Limoges, France.
authors.forename: Seifeddine
authors.initials: S
authors.lastname: Sekkal
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, "Dupuytren" University Hospital, Limoges, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Cornu
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, "Dupuytren" University Hospital, Limoges, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Laskar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D018572:Disease-Free Survival; D005260:Female; D005602:France; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: aortic valve; complications; replacement; surgery