Midterm outcomes of subcoronary stentless porcine valve versus stented aortic valve replacement.
Adult
Aged
Aged, 80 and over
Animals
Aortic Valve
/ physiopathology
Bioprosthesis
Clinical Competence
Cohort Studies
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
/ methods
Hemodynamics
Humans
Male
Middle Aged
Patient Selection
Stents
Surgeons
Swine
Time Factors
Treatment Outcome
Young Adult
aortic stenosis
aortic valve replacement
freestyle
stentless bioprosthesis
subcoronary implantation
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Nov 2020
Nov 2020
Historique:
received:
07
05
2020
revised:
20
07
2020
accepted:
30
07
2020
pubmed:
14
8
2020
medline:
7
4
2021
entrez:
14
8
2020
Statut:
ppublish
Résumé
Stentless porcine xenografts are versatile bioprosthetic valves with the advantage of improved hemodynamics that mimic the function of the native aortic valve. However, these bioprostheses are challenging to implant in the subcoronary position. All consecutive patients who underwent a bioprosthetic aortic valve replacement (AVR) were included from our institutional database. Cox regression analysis was preformed to determine significant predictors for mid term mortality as well as all cause, cardiac, and heart failure readmission. Patients in the subcoronary stentless group were older and more likely to be female and were likely to have a higher Society of Thoracic Surgery risk of mortality. Survival was superior in the stented AVR cohort at 30-days (96.4% vs 90.5%; P < .001), 1-year (90.5% vs 71.6%; P < .001), and 5-year (74.5% vs 56.9%; P < .001) follow up. Acute kidney injury (16.22% vs 5.22%; P < .001) and blood product transfusion (70.27% vs 44.0%; P < .001) were higher in the stentless group. Multivariable analysis revealed subcoronary stentless implantation as a significant independent risk factor for mortality (hazards ratio: 1.92 [1.35,2.72]; P < .001). Stentless porcine xenograft implantation with the Freestyle bioprosthetic in the subcoronary position can be successfully performed in select patients, but its use is associated with increased perioperative morbidity and mortality affecting midterm outcomes. Individual patient selection and surgeon experience are important to ensure favorable outcomes.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2950-2956Informations de copyright
© 2020 Wiley Periodicals LLC.
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