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Ann Thorac Surg 2001;71:601-608
© 2001 The Society of Thoracic Surgeons

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Original article: cardiovascular

Outcome and follow-up of aortic valve replacement with the freestyle stentless bioprosthesis

^a Department of Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
^b Department of Cardiac Surgery, Center Hospitalier Regional, Lille, France
^c Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
^d Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

Address reprint requests to Dr Kappetein, Department of Cardio-Thoracic Surgery, Thoraxcenter, University Hospital Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
e-mail: kappetein{at}thch.azr.nl

Presented at the Thirty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 31–Feb 2, 2000.

Background. The aim of this study was to determine the morbidity, mortality, and hemodynamics after implantation of the Freestyle stentless bioprosthesis in the aortic position.

Methods. A total of 280 patients were operated on from June 1993 to July 1999 as part of a multicenter investigation. Factors influencing hospital mortality and long-term survival were assessed by logistic regression and Cox proportional hazards analysis. Patients were evaluated postoperatively at discharge, at 3 to 6 months, and yearly by clinical examination and color flow Doppler echocardiography.

Results. Hospital mortality in this group was relatively high (9.6%). Logistic regression analysis showed that cross-clamp time, age, myocardial infarction, diabetes, left ventricular hypertrophy, coronary artery disease, New York Heart Association class III or IV and female gender were the independent predictive factors. According to the Kaplan-Meier method, the 4-year survival for hospital survivors was 94%. In the multivariate Cox proportional hazard analysis, only coronary artery disease proved to be prognostic. During follow-up, 11 patients developed paravalvular leakage due to prosthetic dehiscence at the side of the noncoronary cusp. Performance of the prosthesis as assessed by echocardiography was excellent. Mean gradient decreased significantly between discharge and follow-up at 3 to 6 months. At 1-year follow-up trivial regurgitation was found in 6 patients (3%) and mild regurgitation in 4 (2%). Regurgitation did not increase with time. The effective orifice area increased significantly from discharge to follow-up at 3 to 6 months.

Conclusions. Hospital mortality after implantation of a stentless bioprosthesis was higher compared to conventional prosthesis. A high incidence of prosthesis dehiscence at the proximal suture line was found, which was probably due to technique. Hemodynamic performance up to 3 years showed low transvalvular gradients. There is echocardiographic evidence for reduction of left ventricular hypertrophy and improvement of left ventricular function.

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