Pericardial Stentless Valve for Aortic Valve Replacement: Long-Term Results

• Published in: The Annals of thoracic surgery Vol. 102; no. 6; pp. 1956 - 1965
• Main Authors: Repossini, Alberto, MD, Fischlein, Theodor, MD, Santarpino, Giuseppe, MD, Schäfer, Christina, MD, Claus, Benjamin, MD, Passaretti, Bruno, MD, Di Bacco, Lorenzo, MD, Giroletti, Laura, MD, Bisleri, Gianluigi, MD, Muneretto, Claudio, MD, Grubitzsch, Herko, MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.12.2016
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Aortic Valve - surgery; Bioprosthesis - adverse effects; Cardiothoracic Surgery; Endocarditis - drug therapy; Endocarditis - epidemiology; Endocarditis - surgery; Europe - epidemiology; Female; Heart Valve Prosthesis - adverse effects; Heart Valve Prosthesis Implantation - methods; Hemodynamics; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Pacemaker, Artificial - statistics & numerical data; Pericardium; Postoperative Complications - drug therapy; Postoperative Complications - epidemiology; Postoperative Complications - surgery; Proportional Hazards Models; Prosthesis Design; Prosthesis Failure; Reoperation - statistics & numerical data; Surgery; Transcatheter Aortic Valve Replacement - statistics & numerical data; Treatment Outcome
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2016.05.080

Background The Freedom Solo (FS) bovine pericardial valve (Sorin Group, Milan, Italy) is a stentless bioprosthesis that was introduced in 2004 and approved by the United States Food and Drug Administration in 2014. No long-term follow-up series are available to date. We report the multicenter experience of 4 European institutions that began implanting FS extensively from its introduction, providing the largest series with long-term follow-up. Methods From 2004 to 2009, 565 patients (242 women [42.8%]; mean age, 74.6 ± 8.3 years) underwent isolated (n = 350) or combined (n = 215) aortic valve replacement with the FS. Mean follow-up, including clinical and strict echocardiographic evaluation, was 6.9 ± 3.7 years (maximum, 11.8 years; cumulative 2,965 patient-years). Primary end point was freedom from structural valve deterioration (SVD), and secondary end points were freedom from reoperation and overall survival. Results Mean logistic European System for Cardiac Operative Risk Evaluation I was 10.3% ± 6.7%. Overall 30-day mortality was 3.7%, and no deaths were valve related. There was no severe prostheses-patient mismatch, and moderate prostheses-patient mismatch occurred only in 1 patient (0.17%). Twenty-eight patients (5.2%) underwent reoperation (20 surgical replacements, 8 transcatheter aortic valve-in-valve replacements) due to endocarditis in 9, blunt trauma in 1, and SVD in 18. SVD was reported in 5 other patients alive at time of censoring. Freedom from SVD and reoperation was 90.8% (95% confidence interval, 89.1% to 92.5%) and 87.3% (95% confidence interval, 85.6% to 89.0%), respectively, at 10 years of follow-up, and the overall actuarial survival was 56.4% (95% confidence interval, 53.3% to 59.5%). Conclusions The FS valve provided excellent long-term durability and hemodynamic performance in this large, multicenter European experience. Moreover, the FS, given the low rate of SVD, along with a simple implantability, proved to be a reliable bioprosthesis in the aortic position as a valid alternative to stented bioprostheses.