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J Thorac Cardiovasc Surg 2007;133:1045-1050
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

A randomized comparison of the Cryolife O’Brien and Toronto stentless replacement aortic valves

John B. Chambers, MD, FACC*, Helen M. Rimington, BSc, Ronak Rajani, MB, BS, MRCP, Fiona Hodson, RGN, Fikrat Shabbo, MS, FRCS

The Valve Study Group, St Thomas Hospital, London, UK.

Received for publication August 17, 2006; revisions received October 13, 2006; accepted for publication October 23, 2006.

* Address for reprints: Dr John Chambers, Cardiothoracic Centre, St Thomas Hospital, London SE1 7EH, UK. (Email: jboydchambers{at}aol.com).

Objective: A composite stentless valve might be less obstructive than a preparation incorporating the porcine right coronary muscle bar. The aim of this study was to compare early hemodynamic function in a prospective series of 78 patients randomized to receive either a Toronto or Cryolife O’Brien stentless valve.

Methods: Echocardiography was performed early after surgery, between 3 and 6 months, and at 1 year after surgery.

Results: The groups were matched demographically. The Cryolife O’Brien valve was significantly less obstructive in terms of effective orifice area (1.81 vs 1.30 cm2; P < .0001), mean pressure difference (7.1 vs 11.7 mm Hg; P < .0001), and peak velocity (1.7 vs 2.2 m/s) assessed at 1 year (P = .001). Bypass time was 91 (SD 22) minutes for the Cryolife O’Brien compared with 125 (SD 22) minutes (P < .0001) for the Toronto. There was a higher incidence of paraprosthetic regurgitation in the Cryolife O’Brien valve (16.7% vs 3.2%). Mortality and clinical events were similar.

Conclusion: The composite valve was less obstructive than the porcine valve, suggesting that stentless valves cannot be considered as a homogeneous class.

Abbreviations and Acronyms ANOVA = analysis of variance; CSA = left ventricular outflow cross-sectional area; {Delta}P = pressure difference; EOA = effective orifice area; LV = left ventricular; LVDD = left ventricular diastolic diameter; NYHA = New York Heart Association; v1 = subaortic peak velocity; v2 = transaortic peak velocity; VTI1 = subaortic velocity integral; VTI2 = aortic velocity integral




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