Long-term results of aortic valve replacement with the St. Jude Toronto stentless porcine valve

Background. Long-term survival and freedom from valve-related events of the St. Jude Toronto stentless porcine valve (SPV) are unknown. The aim of this study was to investigate late clinical outcomes after aortic valve replacement with the Toronto SPV. Methods. Between 1992 and 2000, 200 patients (131 males, 69 females) underwent aortic valve replacement with the Toronto SPV. Mean patient age at implantation was 64.6 +/- 10.9 years (range 33 to 82 years). At the time of operation, 32%, 51%, and 17% of patients were in New York Heart Association class I/II, III, and IV, respectively. Aortic stenosis, aortic insufficiency, and combined lesions were present in 64%, 13.5%, and 22.5% of patients preoperatively. Concomitant coronary artery bypass grafting was performed in 34.5% of patients. Results. Perioperative mortality occurred in 2.5% (5/200) of patients. There were 31 late deaths. Actuarial survival at 5 and 10 years was 89.2% and 68.0%, respectively. There was no significant difference in overall actuarial survival between isolated valve patients and valve plus coronary artery bypass grafting patients, 71% versus 62% respectively, p = 0.85. Actuarial freedom from valve reoperation at 5 and 10 years was 97.6% and 79.9%, respectively. Actuarial freedom from structural valve deterioration was 98.8% at 5 years and declined to 77.9% at 10 years. Freedom from structural valve deterioration was poorer in patients with preoperative aortic insufficiency or bicuspid disease. Actuarial freedom from embolic events and endocarditis at 10 years were 94.6% and 95.9%, respectively. Conclusions. Although early clinical results were excellent, a significant increase in hazard for structural valve deterioration occurred in late follow-up. (C) 2004 by The Society of Thoracic Surgeons.