VALVE-REPLACEMENT WITH A STENTLESS BIOPROSTHESIS - VERSATILITY OF THEPORCINE AORTIC ROOT

Objective: Stentless valves convey important hemodynamic benefits but are used selectively depending on aortic root structure. The Freestyle valve (Medtronic, Inc, Minneapolis, Minn) is a versatile device that can be implanted by different methods depending on operating condition s. We aimed to demonstrate that a stentless valve could be used in eve ry patient without increased risk of morbidity or mortality. We docume nted the effects of this valve on clinical outcome and left ventricula r mechanics. Methods: The Freestyle valve was implanted by the modifie d subcoronary method into 200 consecutive unselected patients who rece ived a tissue valve in the aortic position and by root replacement in 2, Forty-three percent were older than 75 years. Forty percent underwe nt coronary bypass. Detailed clinical and echocardiographic follow-up (Food and Drug Administration protocol) was used out to 3 years. Resul ts: Mean ischemic time was 43 +/- 6 minutes for isolated aortic valve replacement and 63 +/- 14 minutes with concomitant procedures. Thirty- day mortality was 6%, none of the deaths being valve related. Hemodyna mic function improved progressively with falling valve gradients and i ncreased effective orifice areas. Left ventricular mass fell within no rmal limits over 2 years, but at 3 years there was a non-valve-related upswing. No instances of valve thrombosis, hemolysis, or paravalvular leak were noted. Less than 5% had mild to moderate aortic regurgitati on, Conclusions: The Freestyle valve can be used in virtually every pa tient with aortic valve disease and provides superlative hemodynamic o utcome. Hospital mortality and morbidity are similar to those reported for stented valves in an elderly population.