The St. Jude Toronto stentless bioprosthesis: Up to 20 years follow-up in younger patients

Christ, Torsten; Claus, Benjamin; Borck, Robin; Konertz, Wolfgang; Grubitzsch, Herko

doi:10.1532/hsf.1252

Cited by 14 publications

(5 citation statements)

References 20 publications

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“…Studies on valve performance during the first decade following valve replacement have reported that structural valve deterioration occur in ≤15% during the first decade post-AV replacement, but its incidence progressively increases thereafter. [26][27][28][29] However, it is known that in young patients the durability of a bioprosthetic valve is not as good as in older patients. In their study, Al-Khaja et al 30 showed that at a mean follow-up of 7.5 years, the reoperation rate of patients younger than 40 years of age was 59%, in patients aged 40-49 the reoperation rate was 44%, and in those aged 50-59, the reoperation rate was 22%.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Echocardiographic Outcomes After Aortic Valve Repair Surgery

Ram

Orlov

Shinfeld

et al. 2019

Innovations�(Phila)

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Objective To assess early and late clinical outcomes in patients who underwent aortic valve repair surgery for aortic valve insufficiency, and to investigate predictors for recurrence. Methods Of 151 consecutive patients who underwent aortic valve repair surgery for varying degrees of aortic insufficiency (AI) in our department between 2004 and 2018, 60 (40%) underwent aortic root replacement, 71 (47%) aortic cusp plication, 31 (20%) subcommissural annuloplasty, 29 (19%) circular annuloplasty, and 28 (18%) autologous pericardial patch augmentation. Results One patient died in the hospital (0.7%). Mean clinical and echocardiographic follow-up was 62±43 months (range 1 to 159) and 50 ± 40 months (range 1 to 158), respectively. The overall survival rate was 99.3% at 1 year and 98% at 5 years of follow-up. Seventeen patients (11.3%) had recurrent severe AI, and all of them underwent reoperation with a mean duration to reoperation of 35 ± 39 months. Risk factors for the development of recurrent significant AI (≥3) or reoperation, by univariable analysis, were unicuspid or bicuspid aortic valve (AV) ( P = 0.018), the use of subcommissural annuloplasty ( P = 0.010), the need for cusp repair ( P = 0.001), and the use of pericardial patch augmentation ( P < 0.001). By multivariable analysis only the use of pericardial patch augmentation emerged as a significant independent predictor for the development of recurrent significant AI (≥3) or reoperation ( P = 0.020). Conclusion AV repair can be performed with low morbidity and mortality, with good early and late clinical outcomes. However, in our experience there was a significant rate of recurrent AI especially in patients who underwent cusp augmentation using glutaraldehyde-treated autologous pericardial patch.

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Section: Discussionmentioning

confidence: 99%

Clinical and Echocardiographic Outcomes After Aortic Valve Repair Surgery

Ram

Orlov

Shinfeld

et al. 2019

Innovations�(Phila)

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“…Current data on the durability of bAVR show a non-linear trend with an inflection point beyond 6 years after operation [ 16 ]. Studies on valve performance have reported rates of freedom from SVD at 10 years up to 85% [ [17] , [18] , [19] , [20] ]. Bourguignon and colleagues [ 5 ] reported excellent long-term valve durability of 17.6 years, with 15/20 years freedom from SVD of 66.8%/38.1%, for patients aged 60 years or younger (median age 54, IQR: 47–57.5 years).…”

Section: Discussionmentioning

confidence: 99%

Bioprosthetic aortic valve replacement in patients aged 50 years old and younger: Structural valve deterioration at long-term follow-up. Retrospective study

Corona

Manganiello

Pepi

et al. 2022

Annals of Medicine &Amp; Surgery

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“…Several studies have shown the encouraging performance of surgical bioprostheses in the first-decade post-surgery with freedom from SVD in > 85% at 10 years. 26,[34][35][36][37] Recent data from the SWEDEHEART registry reported a median survival of 16.2 years (ages 60-64 years) to 6.1 years (age > 85 years) in low-risk patients undergoing bioprosthetic SAVR for severe aortic stenosis. 37 Historically, structural valve degeneration was defined using clinical end points such as valve reintervention or death related to structural valve failure rather than long-term echocardiographic and hemodynamic assessment.…”

Section: Caveats Of Savr Durability Assessmentmentioning

confidence: 99%

Transcatheter Aortic Valve Implantation: Long-Term Outcomes and Durability

Desai

Goel²,

Kleiman³

et al. 2023

Methodist DeBakey Cardiovascular Journal

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Transcatheter aortic valve implantation (TAVI) has become the standard of care in symptomatic older patients with severe aortic stenosis regardless of surgical risk. With the development of newer generation transcatheter bioprostheses, improved delivery systems, better preprocedure planning with imaging guidance, increased operator experience, shorter hospital length of stay, and low short-and mid-term complication rates, TAVI is gaining popularity among younger patients at low or intermediate surgical risk. Longterm outcomes and durability of transcatheter heart valves have become substantially important for this younger population due to their longer life expectancy. The lack of standardized definitions of bioprosthetic valve dysfunction and disagreement about how to account for the competing risks made comparison of transcatheter heart valves with surgical bioprostheses challenging until recently. In this review, the authors discuss the mid-to long-term (≥ 5 years) clinical outcomes observed in the landmark TAVI trials and analyze the available long-term durability data emphasizing the importance of using standardized definitions of bioprosthetic valve dysfunction.

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The St. Jude Toronto stentless bioprosthesis: Up to 20 years follow-up in younger patients

Abstract: In younger patients the Toronto-bioprosthesis provided reliable long-term survival despite limited durability.

Cited by 14 publications

References 20 publications

Clinical and Echocardiographic Outcomes After Aortic Valve Repair Surgery

Clinical and Echocardiographic Outcomes After Aortic Valve Repair Surgery

Bioprosthetic aortic valve replacement in patients aged 50 years old and younger: Structural valve deterioration at long-term follow-up. Retrospective study

Transcatheter Aortic Valve Implantation: Long-Term Outcomes and Durability

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