Aortic valve replacement with the Toronto SPV: long-term clinical and hemodynamic results

Objective: Long-term durability and hemodynamics of stentless valves are unknown. Therefore, this study was under-taken to evaluate long-term clinical and echocardiographic outcome after aortic valve replacement with the Toronto stentless porcine valve (SPV) bioprosthesis at our institution. Methods: Between 1991 and 1998. the Toronto SPV was implanted in 255 patients (mean age. 63 +/- 11 years. range 22-83 years 181 males and 74 females). Preoperative diagnoses Acre aortic stenosis (76%). aortic insufficiency (12%) and mixed lesion (12%). New York Heart Association class III and IV were present in 49% (126/255) of the patients preoperatively. Mean valve size implanted was 26.5 +/- 11 mm and in addition 34% (86/255) of the patients had coronary artery bypass surgery. Results: Early mortality was 0.8% (2/255). Actuarial survival at 7 years was 90 +/- 3%. At 7 years. the freedom from cardiac death was 98 +/- 2%: from valve-related death. 99 +/- 1%; from valve reoperation, 97 +/- 2% from structural valve degeneration. 97 +/- 2%: from thromboembolism. 95 +/- 2%: and from endocarditis, 99 +/- 1%. At 7 years of follow-up, the transvalvular peak and mean pressure differences across the aortic valve measured with Doppler echocardiography was 9.6 +/- 5.1 and 3.6 +/- 2.0 mmHg, respectively. Conclusions: The Toronto SPV has provided excellent clinical and hemodynamic results up until 7 years of follow-up, (C) 2002 Elsevier Science B.V. All rights reserved.