Clinical Outcome of a Simplified Technique for Aortic Valve Replacement with Stentless Bioprostheses

Background and aim of the study: Aortic stentless bio-prostheses provide good clinical and hemodynamic results, but may be difficult to implant. Their use is also contraindicated in the presence of a severely calcified aortic root. The study aim was to assess the mid-term results of a simplified implant technique of the Sorin Pericarbon Freedom stentless bioprosthesis (SPF), that allows its use in the presence of severe aortic root calcification. Methods: Between 2001 and 2007, a total of 51 patients underwent aortic valve replacement (AVR) with the SPF, using a new technique which consisted of standard annular fixation and the fixation of each strut with a single 'U' stitch. The perioperative characteristics, early and late mortality and occurrence of valve-related events were evaluated. The overall mean cross-clamp and cardiopulmonary bypass times were 91.5 +/- 30.2 and 125.3 +/- 44.9 min, respectively, and 77.8 +/- 17.7 and 105.6 +/- 22.8 min, respectively, for AVR (these times were comparable to those required in patients receiving stented valve bioprostheses). The mean follow up period was 40.5 months (range: 3-75 months), and was 100% complete. Results: Hospital mortality was 4% and survival 76.5 +/- 14.5% at six years. Late deaths occurred in eight patients; in four cases this was valve-related (1.9%/patient-year). Freedom from valve-related death and reoperation was 91 +/- 9% and 98 +/- 2% respectively, at six years. The mean transprosthetic gradients were 12.0 +/- 3.4, 9.9 +/- 2.6, 8.7 +/- 4.2, 5.2 +/- 3.9, 4.5 +/- 3.0 and 3.2 +/- 2.7 mmHg for the 19, 21, 23, 25, 27 and 29 mm valve sizes, respectively. No valvular or paravalvular regurgitation was recorded. Conclusion: This new implantation technique for the aortic SPF stentless bioprosthesis is simple, effective and versatile, and showed good early results. It may be applicable to other stentless bioprostheses, and also be particularly useful in patients with small aortic annulus and in those with a calcified aortic root.