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J Thorac Cardiovasc Surg 2005;130:777
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Eight-year results after aortic valve replacement with the CryoLife-O'Brien Stentless Aortic Porcine Bioprosthesis

^a Department of Cardiothoracic Surgery, Klinikum Krefeld, Krefeld, Germany,
^b Department of Cardiovascular Surgery, Justus Liebig University of Giessen, Giessen, Germany

Received for publication February 9, 2005; revisions received May 3, 2005; accepted for publication May 10, 2005.

^_* Address for reprints: Ivo Martinovic, MD, Department of Cardiovascular Surgery, Philipps University Marburg, Baldinger Strasse 6, D-35033 Marburg, Germany (Email: martinov{at}med.uni-marburg.de).

OBJECTIVE: The long-term durability and hemodynamics of stentless valves are largely unknown. In this study we prospectively analyzed 8-year clinical results with the CryoLife-O'Brien Stentless Aortic Porcine Bioprosthesis (CryoLife Inc, Kennesaw, Ga) and assessed its hemodynamic performance by serial echocardiography.

METHODS: A total of 206 patients with a mean age of 72.8 years were followed up prospectively after aortic valve replacement with the CryoLife-O'Brien stentless bioprosthesis. Patients have been followed up from 2 to 96 months for mean 56 months. Echocardiography was performed by a single echocardiographer preoperatively, intraoperatively, postoperatively at discharge, 3 to 6 months later, and annually thereafter.

RESULTS: The 30-day operative mortality was 4.8%. Sixty-five percent of patients received a valve 25 mm in diameter or larger, and 37% underwent concomitant coronary bypass grafting. Twelve late deaths, none valve-related, have occurred. Severe aortic insufficiency caused by oversizing led to early reoperation in 3 patients. The peak and mean systolic gradients decreased significantly during the first 12 months after implantation (P < .001), and the effective valve areas increased significantly during this interval (P < .001). At 8 years, 2 patients have mild to moderate aortic insufficiency. The actuarial survival at 8 years was 82% ± 3%. The freedom from endocarditis was 100%, and the freedom from thromboembolic events was 93%.

CONCLUSION: Despite more demanding surgical technique than with conventional bioprostheses, the CryoLife-O'Brien bioprosthesis can be implanted safely in a population predominantly older than 70 years at the time of the operation, with excellent measures of hemodynamics, clinical outcomes, prosthesis durability, and survival through 8 years.

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