Does the Use of Stentless Aortic Valves in a Subcoronary Position Prevent Patient-Prosthesis Mismatch for Small Aortic Annulus?

Lopez, Stéphane; Mathieu, Patrick; Pîbarot, Philippe; Mohammadi, Siamak; Dagenais, François; Voisine, Pierre; Dumesnil, Jean G.; Doyle, D. John

doi:10.1111/j.1540-8191.2008.00631.x

Cited by 19 publications

(19 citation statements)

References 21 publications

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“…30 The incidence of PPM at discharge varies between 20% and 70% in the literature [31][32][33] and may be as high as 91% in patients with a small aortic annulus. 34 A tendency to use this type of prosthesis in patients at risk of PPM (eg, women) may explain the relatively high incidence of PPM in our series. However, the incidence of severe mismatch was 9.2% in the present study.…”

Section: Patient-prosthesis Mismatchmentioning

confidence: 71%

Long-Term Clinical and Echocardiographic Follow-Up of the Freestyle Stentless Aortic Bioprosthesis

et al. 2012

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Background-Stentless aortic bioprostheses were designed to provide enhanced hemodynamic performance and potentially greater longevity. The present report describes the outcomes of patients with the Freestyle stentless bioprosthesis followed for Յ18 years. Methods and Results-Between 1993 and 2011, 430 patients underwent primary aortic valve replacement with a Freestyle bioprosthesis in the subcoronary position. Mean age was 68.2Ϯ8.2 years. All of the clinical and echocardiographic data were collected prospectively. Mean overall follow-up was 9.1Ϯ4.4 years and was complete in all of the patients. In-hospital mortality was 3.5% (nϭ15). Overall, 10-and 15-year survival were 60.7% and 35.0%, respectively. Fifty-one patients required reoperation during follow-up, including 27 for structural valve deterioration (SVD). Overall, freedom from reoperation was 91.0% and 75.0% at 10 and 15 years, whereas freedom from reoperation for SVD was 95.9% and 82.3%, respectively. At 10 and 15 years, freedom from reoperation for SVD was 94.0% and 62.6% for patients Ͻ60 years of age and 96.3% and 88.4% for patients Ն60 years of age (Pϭ0.002). The median time to explant for SVD was 10.7 years. SVD presented mostly as acute, severe aortic insufficiency attributed to leaflet tear (77.8%).The independent risk factors for reoperation for SVD were age Ͻ60 years (Pϭ0.001) and dyslipidemia (Pϭ0.02). Conclusions-Aortic valve replacement with the Freestyle bioprosthesis in a subcoronary position provides good long-term clinical and echocardiographic outcomes for patients Ͼ60 years of age. Severe aortic insufficiency with leaflet tear is the major mode of SVD leading to reoperation in these patients. (Circulation. 2012;126[suppl 1]:S198 -S204.)

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Section: Patient-prosthesis Mismatchmentioning

confidence: 71%

Long-Term Clinical and Echocardiographic Follow-Up of the Freestyle Stentless Aortic Bioprosthesis

et al. 2012

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“…Nonetheless, the results of the present study showed that the incidence of severe PPM remains high with both stented and stentless bioprostheses among patients with a small aortic annulus. Lopez et al (22) reported a high rate (58%) of severe PPM among patients with a small aortic root undergoing SAVR with the Freestyle stentless bioprosthesis, and that was associated with high (Ͼ30%) perioperative mortality. Interestingly, the results of the present study reveal that the post-operative improvement in the valve hemodynamic performance that is observed with stentless bioprostheses essentially occurs in patients with a medium or large aortic annulus, whereas it is minimal or absent in patients with a small aortic annulus, who are precisely those at highest risk for severe PPM.…”

Section: Discussionmentioning

confidence: 98%

Comparison of the Hemodynamic Performance of Percutaneous and Surgical Bioprostheses for the Treatment of Severe Aortic Stenosis

Clavel

Webb

Pîbarot

et al. 2009

Journal of the American College of Cardiology

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“…Furthermore, the hemodynamic superiority of stentless aortic bioprostheses continues to be debated, with available studies reporting conflicting data, both for normal (24,25,29) and smallsized aortic annuli (30 -32). Our center published its (32). The incidence of severe PPM was 58% and 17% for the 19-and 21-mm prostheses, respectively.…”

Section: Discussionmentioning

confidence: 98%

Transcatheter Aortic Valve Implantation in Patients With Severe Aortic Stenosis and Small Aortic Annulus

Kalavrouziotis

Rodés‐Cabau

Bagur

et al. 2011

Journal of the American College of Cardiology

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Does the Use of Stentless Aortic Valves in a Subcoronary Position Prevent Patient-Prosthesis Mismatch for Small Aortic Annulus?

Abstract: AVR with small size Freestyle subcoronary implants is associated with a high incidence of PPM and high mortality.

Cited by 19 publications

References 21 publications

Long-Term Clinical and Echocardiographic Follow-Up of the Freestyle Stentless Aortic Bioprosthesis

Long-Term Clinical and Echocardiographic Follow-Up of the Freestyle Stentless Aortic Bioprosthesis

Comparison of the Hemodynamic Performance of Percutaneous and Surgical Bioprostheses for the Treatment of Severe Aortic Stenosis

Transcatheter Aortic Valve Implantation in Patients With Severe Aortic Stenosis and Small Aortic Annulus

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