The St. Jude Toronto stentless bioprosthesis: Up to 20 years follow-up in younger patients
DOI:
https://doi.org/10.1532/hsf.1252Abstract
Background:A retrospective long-term evaluation of the St. Jude Toronto stentless bioprosthesis in patients aged 60 years or younger.
Methods:From 1994 to 1997, 50 patients underwent aortic valve replacement with the prosthesis. Patients mean age at surgery was 54.5±6.3 years. Follow-up data were acquired by patient file research and telephone interviews. Morbidity and mortality were evaluated with time-to-event analyses using the Kaplan-Meier-method. The log-rank test was used to determine influencing factors for long-term survival and reoperation.
Results:Mean follow-up was 13.5±6.3 years with a total follow-up of 661.8 patient-years and a maximum of 20.0 years. Follow-up was 97.8% complete. Associated procedures were performed in 12 patients (24%), including coronary artery bypass grafting, mitral valve replacement and replacement of the ascending aorta. Freedom from reoperation at 10 and 15 years was 76.0±6.7% and 44.1±8.9%, respectively. Reoperations (n=26) started 4.4 years after implantation and were necessary due to: valve degeneration with regurgitation in 79.2% and stenosis in 12.5%, endocarditis in 4.2% and sinus valsalva aneurysm in 4.2% of the cases. The log-rank test revealed that only body-mass-index>25 lowered freedom-from-reoperation, while renal dysfunction, diabetes mellitus and arterial hypertension were not. Overall long-term survival at 10 and 20 years was 82.3±5.7% and 49.9±8.9%, respectively.
Conclusion:In younger patients the Toronto-bioprosthesis provided reliable long-term survival despite limited durability.
References
Bonow RO, Carabello B, de Leon AC Jr, et al. Guidelines for the management of patients with valvular heart disease: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). Circulation 1998;98(18):1949-1984.
Chiang YP, Chikwe J, Moskowitz AJ, Itagaki S, Adams DH, Egorova NN. Survival and Long-term Outcomes Following Bioprosthetic vs Mechanical Aortic Valve Replacement in Patients Aged 50 to 69 Years. JAMA 2014;312(13):1323. doi:10.1001/jama.2014.12679.
Christ T, Grubitzsch H, Claus B, Heinze G, Dushe S, Konertz W. Hemodynamic behavior of stentless aortic valves in long term follow-up. J. Cardiothorac. Surg. 2014;9(1):197. doi:10.1186/s13019-014-0197-2.
Christ T, Grubitzsch H, Claus B, Konertz W. Long-term follow-up after aortic valve replacement with Edwards Prima Plus stentless bioprostheses in patients younger than 60 years of age. J. Thorac. Cardiovasc. Surg. 2014;147(1):264-269. doi:10.1016/j.jtcvs.2012.10.032.
Christ T, Grubitzsch H, Claus B, Konertz W. Stentless aortic valve replacement in the young patient: long-term results. J. Cardiothorac. Surg. 2013;8(1):68. doi:10.1186/1749-8090-8-68.
David TE, Feindel CM, Bos J, Ivanov J, Armstrong S. Aortic valve replacement with Toronto SPV bioprosthesis: Optimal patient survival but suboptimal valve durability. J. Thorac. Cardiovasc. Surg. 2008;135(1):19–24.
Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J. Am. Coll. Cardiol. 2000;36(4):1152.
Kobayashi J. Stentless aortic valve replacement: an update. Vasc. Health Risk Manag. 2011;7:345-351. doi:10.2147/VHRM.S11253.
Konertz W, Herrmann M, Knauth M, Stabenow I, David T. Preliminary experience with the Toronto SPV stentless porcine bioprosthesis for aortic valve replacement. Thorac. Cardiovasc. Surg. 1994;42(1):36-39. doi:10.1055/s-2007-1016452.
Kunadian B, Vijayalakshmi K, Thornley AR, et al. Meta-Analysis of Valve Hemodynamics and Left Ventricular Mass Regression for Stentless Versus Stented Aortic Valves. Ann. Thorac. Surg. 2007;84(1):73-78. doi:10.1016/j.athoracsur.2007.02.057.
Lehmann S, Walther T, Kempfert J, et al. Stentless Versus Conventional Xenograft Aortic Valve Replacement: Midterm Results of a Prospectively Randomized Trial. Ann. Thorac. Surg. 2007;84(2):467-472. doi:10.1016/j.athoracsur.2007.02.017.
Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease. J. Am. Coll. Cardiol. 2014;63(22):e57-e185. doi:10.1016/j.jacc.2014.02.536.
Oxenham H, Bloomfield P, Wheatley DJ, et al. Twenty year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses. Heart Br. Card. Soc. 2003;89(7):715-721.
Rahimtoola SH. Choice of prosthetic heart valve in adults an update. J. Am. Coll. Cardiol. 2010;55(22):2413-2426. doi:10.1016/j.jacc.2009.10.085.
Ruel M, Chan V, Bédard P, et al. Very long-term survival implications of heart valve replacement with tissue versus mechanical prostheses in adults <60 years of age. Circulation 2007;116(11 Suppl):I294-300. doi:10.1161/CIRCULATIONAHA.106.681429.
Sidiropoulos A, Hotz H, Tschesnow J, Konertz W. Stentless porcine bioprostheses for all types of aortic root pathology. Eur. J. Cardio-Thorac. Surg. Off. J. Eur. Assoc. Cardio-Thorac. Surg. 1997;11(5):917-921.
Statistisches Bundesamt Wiesbaden, ed. Bevölkerung und Erwerbstätigkeit, Fachserie 1, Reihe 1, Gebiet und Bevölkerung 1993: Ed. Statistisches Bundesamt Wiesbaden, Metzler-Poeschel Verlag, Stuttgart 1995, 178-179.
Une D, Ruel M, David TE. Twenty-year durability of the aortic Hancock II bioprosthesis in young patients: is it durable enough? Eur. J. Cardio-Thorac. Surg. Off. J. Eur. Assoc. Cardio-Thorac. Surg. 2014;46(5):825-830. doi:10.1093/ejcts/ezu014.
Valfre C, Ius P, Minniti G, et al. The fate of Hancock II porcine valve recipients 25 years after implant. Eur. J. Cardiothorac. Surg. 2010;38(2):141.
Walther T, Falk V, Langebartels G, et al. Prospectively randomized evaluation of stentless versus conventional biological aortic valves: impact on early regression of left ventricular hypertrophy. Circulation 1999;100(19 Suppl):II6-10.
Welke KF, Wu Y, Grunkemeier GL, Ahmad A, Starr A. Long-term Results after Carpentier-Edwards Pericardial Aortic Valve Implantation, with Attention to the Impact of Age. Heart Surg. Forum 2011;14(3):E160-165. doi:10.1532/HSF98.20101140.
