Aortic valve replacement with the Biocor PSB stentless xenograft

Background. The midterm clinical results after aortic valve replacement with the Biocor PSB stentless xenograft on all patients operated between October 1992 and October 1996 were reviewed. Methods. One hundred six patients, aged 70 +/- 6 years, had aortic valve replacement for aortic stenosis (67%), regurgitation (11%), or both (22%). Associated procedures were done in 49 patients (46%), including coronary artery bypass in 30 patients, mitral valve repair/replacement in 16, and ascending aorta replacement in 5 patients. Aortic cross-clamp and cardiopulmonary bypass times were 96 +/- 24 and 129 +/- 31 minutes, respectively. Results. There were 3 (3%) early deaths due to low output (2 patients) and cerebrovascular accident (1 patient). Follow-up of survivors ranged from 6 to 66 months (mean, 39 +/- 14 months). Survival was 94% +/- 2% and 90% a 3% at 1 and 5 years. There were 5 late deaths due to cardiac cause (2), cancer (2), and pulmonary embolism (I patient). No patient had structural valve deterioration, whereas 100% and 95% +/- 3% were free from valve-related events at I and 5 years. There were two reoperations due to narrowing of the left coronary ostium and endocarditis, with an actuarial freedom from reoperation of 99% +/- 1% and 98 +/- 1% at 1 and 5 years, respectively. Functional results demonstrated a mean peak transprosthetic gradient of 16 +/- 12 mm Hg, with only 1 patient (1%) with a 55 mm Hg gradient. No cases of valve regurgitation greater than mild were recorded at followup. Assessment of New York Heart Association functional class demonstrated a significant improvement (2.9 +/- 0.6 versus 1.4 +/- 0.7; p = 0.01). All patients were free from anticoagulation. Conclusions. Aortic valve replacement using the Biocor PSB stentless xenograft offers excellent midterm survival, negligible valve deterioration, and a very low rate of valve-related events, which are comparable to estimates reported with other models of stentless xenografts and currently available stented xenografts. Hemodynamic performance is favorable and quality of life satisfactory. (C) 1998 by The Society of Thoracic Surgeons.