Clinical and hemodynamic comparison of the Medtronic Freestyle and TorontoSPV stentless valves

The excellent hemodynamics of stentless valves have been observed by numero us investigators. With the recent release of the Toronto SPV (stentless por cine valve) and the Medtronic Freestyle stentless valves in North America, it is appropriate to now compare the clinical and hemodynamic performance o f these devices. We analyzed the results of 995 patients who underwent aort ic valve replacement (AVR) with either of the two valves; in all cases a su bcoronary implant technique was used. There were important differences in t he preoperative characteristics for the two groups: Medtronic Freestyle pat ients were notably older than the Toronto SPV patients (70.7 +/- 8.6 vs 61. 8 +/- 11.1 years, p < 0.001) and were markedly more symptomatic (p < 0.0001 ). In the Toronto SPV group, most patients had New York Heart Association ( NYHA) Class II (41.5%) or Class III (44.7%) symptoms preoperatively, while in the Freestyle group, 61.5% were in Class III and 12.5% were in Class IV. There were no notable differences in mortality or morbidity for the two gr oups. Both devices demonstrated a meaningful decrease in mean gradient and a corresponding increase in effective orifice area (EOA). Furthermore, the indexed EOA (EOA/body surface area [BSA]) was > 1cm(2)/m(2) for all valves indicating there was no patient-prosthetic mismatch. There was a meaningful decrease in left ventricular (LV) mass as well as LV mass index (LVMI) for both devices up to 3 years postoperatively. Our data indicate that there w ere no differences in clinical outcome or hemodynamic performance of these two valves. Both devices offer excellent results with normalization of LV f unction.