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Cryolife-O’Brien stentless valve: 10 year results of 402 implants

O'Brien, Mark F., Gardner, Michael A. H., Garlick, Bruce, Jalali, Homayoun, Gordon, Julie A., Whitehouse, Sarah L., Strugnell, Wendy E., & Slaughter, Richard E. (2005) Cryolife-O’Brien stentless valve: 10 year results of 402 implants. Annals of Thoracic Surgery, 79(3), pp. 757-766.

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Abstract

Background
This truly stentless porcine valve is composite, without Dacron and implanted supra-annularly. Ten year analysis with magnetic resonance imaging is presented. Methods From 1992 to 2002, 402 patients (mean 73.5 yrs) had aortic valve replacement. Associated procedures were required in 252 patients (63%). Serial echoes provided 1340 studies. Clinical follow-up was 100%. Magnetic Resonance Imaging focused on aortic annulus extensibility. Results The 30 day mortality was 0.99% (4 deaths). Morbidity comprised (a) thromboembolism (40 patients including 18 patients with permanent strokes); (b) endocarditis (nine patients); (c) re-operation (nine patients) - peri-prosthetic leak (2), endocarditis (5), technical needle damage (1) and structural degeneration (1). Of 402 valves over 10 years, five valves were explanted, one only for structural failure. Except for endocarditis (2), no late deaths (69 pts, 1.5 months – 5.7 yrs) were valve related. Echocardiography demonstrated low gradients with good orifice areas, excellent ventricular regression (p = 0.0001 pre and post-operative comparisons) and late incompetence - mild (45 pts) and moderate (nine pts). No living patient has severe incompetence. Magnetic Resonance Imaging demonstrated the annulus ‘expanding and relaxing’ throughout the cardiac cycle, the mean increase in cross-sectional area being 37%, resembling normal aortic root dynamics. Conclusion Elderly patients received this hemodynamically acceptable valve with its simple, supra-annular implantation and satisfactory mid-term morbid-free lifestyle to 10 years maximum follow-up. With only one structural failure, restoration of valve annular extensibility may have a favourable influence on long-term durability.

Impact and interest:

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ID Code: 5596
Item Type: Journal Article
DOI: 10.1016/j.athoracsur.2004.08.057
ISSN: 0003-4975
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > CLINICAL SCIENCES (110300) > Surgery (110323)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > CARDIOVASCULAR MEDICINE AND HAEMATOLOGY (110200) > Cardiology (incl. Cardiovascular Diseases) (110201)
Divisions: Past > QUT Faculties & Divisions > Faculty of Built Environment and Engineering
Copyright Owner: Copyright 2005 Elsevier
Copyright Statement: Reproduced in accordance with the copyright policy of the publisher.
Deposited On: 28 Nov 2006
Last Modified: 29 Feb 2012 23:11

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