P54. Retrospective Clinical Analysis of Stentless Porcine Aortic Bioprostheses
OBJECTIVE: The study was designed to access retrospectively hemodynamic performance, structural failure and survival of patients undergoing aortic valve replacement (AVR) with a composite aortic, aldehyde tanned, stentless porcine bioprosthesis.
METHODS: From January 1990 to June 1999, 205 patients receiving aortic stentless valves were reviewed as far as age, sex, valve lesion, valve size, pre and post-operative NYHA class, hospital morbidity, mortality, operative data, length of hospitalization and patient follow up.
RESULTS: The patients demographics showed a mean age of 46 years, 72% male patients, slight predominance of aortic insufficiency (47%). There was a 44% incidence of rheumatic heart disease requiring surgery. Twenty five percent of the patients had prior aortic bioprosthetic dysfunction. Seventy eight percent of the patients were in preoperative NYHA functional class III and IV. The stentless bioprosthesis valve size used was 25mm and below in 72% of the patients. The mean intensive care unit stay was 2.6 days. The mean hospital stay was 11 days. The hospital mortality was 4.4% and late patients death was 7.1%. Valve related death was 0%. The number of patients available for follow up, excluding hospital and late mortality, reoperations and patients lost to follow-up, was 175. Postoperatively, the mean aortic effective orifice area (AEOA) was 1.6 cm2, the mean transvalvular peak gradient was 17.9 mmHg and mean transvalvular gradient was 9.3 mmHg. Postoperative left ventricular mass (g/m2) decreased from 172 to 118. The rate of leaflet tissue degeneration was 0.6%. Actuarial patient survival at 10 years was 72% and freedom from reoperations was 99%.
CONCLUSION: Hemodynamic benefits in these stentless patients were evident as expressed by good AEOA, low transvalvular gradients, better left ventricular remodeling with significant decrease of the left ventricular mass. Low complication rate, low reoperation rate, low leaflet tissue degeneration, as well as low valve related mortality rate were seen in this patient population. A longer follow up may still be required to confirm these clinical and hemodynamic benefits.