Clinical performance of a sutureless aortic bioprosthesis: Five-year results of the 3f Enable long-term follow-up study

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 148; no. 4; pp. 1681 - 1687
• Main Authors: Englberger, Lars, MD, Carrel, Thierry P., MD, Doss, Mirko, MD, Sadowski, Jerzy, MD, Bartus, Krzysztof, MD, Eckstein, Friedrich F., MD, Asch, Federico M., MD, Martens, Sven, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2014
• Subjects: Aged; Aortic Valve - surgery; Aortic Valve Stenosis - surgery; Bioprosthesis; Cardiothoracic Surgery; Echocardiography; Female; Follow-Up Studies; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - methods; Hemodynamics; Humans; Longitudinal Studies; Male; Postoperative Complications - epidemiology; Prospective Studies; Prosthesis Design; Sternotomy; Treatment Outcome; NYHA; transcatheter aortic valve implantation; 35; aortic valve replacement; TTE; PVL; TAVI; transthoracic echocardiography; 35.3.3; PPM; effective orifice area; 35.2; New York Heart Association; EOAi; indexed effective orifice area; EOA; prosthesis–patient mismatch; paravalvular leak; AVR
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2014.03.054

Objective Sutureless valves are designed to facilitate surgical implantation, including less-invasive techniques in aortic valve replacement, by maintaining surgical precision of implantation compared with transcatheter techniques. Long-term clinical experience with sutureless valves is lacking. We report the 5-year follow-up results of an international, prospective, multicenter study evaluating the clinical performance and safety of the 3f Enable valve (Medtronic Inc, Minneapolis, Minn). Methods Between March 2007 and December 2009, 141 patients (54 male; mean age, 76.1 ± 5.7 years) undergoing aortic valve replacement with the 3f Enable valve were enrolled in 10 European sites. The mean follow-up was 2.76 years (range, 2 days to 5.1 years; total, 388.7 patient-years). Echocardiographic valvular hemodynamic and morphologic analyses were performed by an independent core laboratory. Results The mean systolic gradient was 10.4 ± 4.4 mm Hg at discharge and 7.7 ± 4.1 mm Hg at 5 years. The mean effective orifice area was 1.7 ± 0.5 cm2 at discharge and 1.6 ± 0.2 cm2 at 5 years. Freedom from all-cause and valve-related mortality was 87.6% ± 2.9% and 96.8% ± 1.6% at 1 year (113 patients at risk) and 77.0% ± 7.5% and 93.8% ± 4.8% at 5 years (24 patients at risk), respectively. Six patients underwent reoperation (4 because of major paravalvular leakage and 2 because of endocarditis). Freedom from reoperation was 95.4% ± 1.9% at 1 year and 95.4% ± 6.1% at 5 years. No structural valve deterioration occurred during the follow-up period. Conclusions The sutureless 3f Enable valve represents a safe and effective treatment for aortic valve stenosis, providing an excellent hemodynamic profile. This study represents the longest follow-up study for a sutureless bioprosthesis. Sutureless valves may become an option for all patients with indicated biological aortic valve replacement.