Long-Term Clinical and Echocardiographic Follow-Up of the Freestyle Stentless Aortic Bioprosthesis

[摘要] Background-Stentless aortic bioprostheses were designed to provide enhanced hemodynamic performance and potentially greater longevity. The present report describes the outcomes of patients with the Freestyle stentless bioprosthesis followed for <= 18 years. Methods and Results-Between 1993 and 2011, 430 patients underwent primary aortic valve replacement with a Freestyle bioprosthesis in the subcoronary position. Mean age was 68.2 +/- 8.2 years. All of the clinical and echocardiographic data were collected prospectively. Mean overall follow-up was 9.1 +/- 4.4 years and was complete in all of the patients. In-hospital mortality was 3.5% (n = 15). Overall, 10- and 15-year survival were 60.7% and 35.0%, respectively. Fifty-one patients required reoperation during follow-up, including 27 for structural valve deterioration (SVD). Overall, freedom from reoperation was 91.0% and 75.0% at 10 and 15 years, whereas freedom from reoperation for SVD was 95.9% and 82.3%, respectively. At 10 and 15 years, freedom from reoperation for SVD was 94.0% and 62.6% for patients <60 years of age and 96.3% and 88.4% for patients >= 60 years of age (P = 0.002). The median time to explant for SVD was 10.7 years. SVD presented mostly as acute, severe aortic insufficiency attributed to leaflet tear (77.8%). The independent risk factors for reoperation for SVD were age <60 years (P = 0.001) and dyslipidemia (P = 0.02). Conclusions-Aortic valve replacement with the Freestyle bioprosthesis in a subcoronary position provides good long-term clinical and echocardiographic outcomes for patients >60 years of age. Severe aortic insufficiency with leaflet tear is the major mode of SVD leading to reoperation in these patients. (Circulation. 2012;126[suppl 1]:S198-S204.)

[效力级别]  Proceedings Paper

[关键词] PROSTHESIS-PATIENT MISMATCH;VALVE-REPLACEMENT;HEMODYNAMICALLY SUPERIOR;STENTED VALVES;IMPACT;SURVIVAL;MORTALITY;FAILURE;DURABILITY;EXERCISE