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J Thorac Cardiovasc Surg 2005;129:1041-1049
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Which biologic valve should we select for the 45- to 65-year-old age group requiring aortic valve replacement?

F. Dagenais, MD^_*, P. Cartier, MD, P. Voisine, MD, D. Desaulniers, MD, J. Perron, MD, R. Baillot, MD, G. Raymond, MD, J. Métras, MD, D. Doyle, MD, P. Mathieu, MD

Department of Cardiac Surgery, Laval Hospital, Quebec City, Quebec, Canada.

Read at the Thirtieth Annual Meeting of The Western Thoracic Surgical Association, Maui, Hawaii, June 23–26, 2004.

Received for publication July 2, 2004; revisions received October 12, 2004; accepted for publication October 21, 2004.

^_* Address for reprints: Francois Dagenais, Department of Cardiac Surgery, Laval Hospital, 2725 chemin Sainte-Foy, Sainte Foy, Québec, Canada, G1V 4G5 (E-mail: francois.dagenais{at}chg.ulaval.ca).

OBJECTIVE: The diversity of biologic valves available to replace the aortic valve renders selection difficult for the 45- to 65-year-old patient. To evaluate and compare the results of biologic valves in the 45- to 65-year-old patient, we reviewed our experience (1991–2004).

METHODS: Three hundred thirty-two patients between 45 and 65 years old with isolated aortic valve disease had a biologic valve implanted: Freestyle valve in 140 patients, a homograft in 54 patients, a stented Mosaic or Perimount valve (stented xenograft) in 62 patients, and a Ross procedure in 76 patients.

RESULTS: Perioperative mortality was comparable for all groups (Freestyle, 2.1%; homograft, 3.7%; stented xenograft, 3.2%; Ross procedure, 1.3%; P = .8). Echocardiographically determined valve performance at discharge was significantly enhanced in the Ross procedure and homograft groups (indexed effective orifice area: Freestyle, 0.9 ± 0.3 cm²/m²; homograft, 1.3 ± 0.3 cm²/m²; stented xenograft, 0.8 ± 0.2 cm²/m²; Ross procedure, 1.4 ± 0.4; P < .0001; mean gradient: Freestyle, 12.0 ± 6.6 mm Hg; homograft, 7.4 ± 4.0 mm Hg; stented xenograft, 15.4 ± 5.4 mm Hg; Ross procedure, 4.6 ± 3.2 mm Hg; P < .0001). For all yearly follow-up, freedom from New York Heart Association class III or IV was comparable and greater than 95% for all groups. At 7 years, cardiac survival (homograft, 96.3% ± 3.7%; Ross procedure, 90.6% ± 6.3%; stented xenograft, 86.0% ± 10.3%; Freestyle, 89.2% ± 10.8%; P = .7) and freedom from reoperation (Ross procedure, 98.5% ± 1.4%; homograft, 90.6% ± 5.7%; Freestyle, 88.0% ± 4.9%; stented xenograft, 90.0% ± 8.0%; P = .4) were comparable. Freedoms from significant bleeding events, valve-related neurologic events, or endocarditis were comparable and greater than 95% for all groups.

CONCLUSION: Type of aortic biologic valve for the 45- to 65-year-old patient does not affect midterm survival or valve-related morbidity. Thus the choice of biologic valve for the 45- to 65-year-old patient should be dictated by patient-surgeon preference, ease of implantation, and reoperation until longer comparative studies are available.

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