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Rationale For Extensive Use Of A Pericardial Stentless Aortic Xenograft: Excellent Early Outcome And Medium-term. Results After 250 Consecutive Implants.

Guglielmo Stefanelli1, Fabrizio Pirro1, Clorinda Labia1, Giuseppe D'Anniballe1, Domenico Sarandria2, Filippo Benassi1, Stefano Marazia1.
1Hesperia Hospital, Modena, Italy, 2Villa Berica Hospital, Vicenza, Italy.


BACKGROUND:Aim of this study was to investigate the durability and the hemodynamic behaviour at rest and after a short stress-test of a stentless pericardial aortic xenograft(Sorin Freedom® SF)
METHODS: Between march,2003 and April,2010,250 consecutive,non selected patients received a SF bioprosthesis as aortic valve substitute at our institution,by a single surgeon, using a classic double-line sub-coronary implant.Age ranged between 17 an 89 years(mean:68,7),with 16% of pts. older than 80.16 pts had an acute bacterial endocarditis.110 pts(44%) received associated procedures.Mean Euroscore was 6,6,being greater than 10 in 15% of pts.Valve size ranged between 19 and 29.Patients were followed for complications and hemodynamics.Echo controls were obtained at discharge,at 6 months and at last follow-up,at rest and after a short stress-test.Statistical analysis of the data was carried out with p<005 considered as level of significance.
RESULTS: In hospital/30 days mortality was 1,2% for the entire group(0% for isolated valve replacement).23 deaths have occurred during the follow-up time,19 of whom for non-cardiac causes.At follow-up(1-97 months),87% of the survivors were in NYHA class I.Freedom from reoperation,and/or structural valve deterioration or malfunction was 97% at 8 years.Freedom from prosthetic bacterial endocarditis was 98% at 8 yrs.The mean pressure gradient of the series,measured by Echo,was 10,1±3,6 mmHg at discharge,8,6±4,6 mmHg at the time of follow-up, increasing to 9,2±3,6 after the stress-test.Indexed mean LV mass regression was 27% at 6 months.
CONCLUSIONS:Our experience confirm favourable hemodynamic behaviour and durability of the pericardial stentless SF aortic prosthesis and endorses its routine use as first choice aortic valve substitute.Accuracy of the implant remains a crucial factor for durable and satisfactory performances.
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