Clinical and hemodynamic performance of the Toronto SPV bioprosthesis

Background and nim of the study: By providing a superior hemodynamic profil e, the stentless valve design allows ventricular remodeling and may improve patient survival after aortic valve replacement (AVR). Compared with stent -mounted prostheses, implantation is more complex and requires a longer isc hemic time; this may adversely affect surgical risk, especially if patients are elderly or require a concomitant procedure. The mid-term clinical and hemodynamic performance of the Toronto SPV bioprosthesis in a predominantly elderly patient group was analyzed. Methods: A total of 123 patients (median age 72 years) underwent AVR with t he Toronto SPV. Concomitant procedures (mainly coronary artery bypass graft ing, CABG), were performed in 60 patients (49%). Clinical details were reco rded, with 100% follow up (total 317 patient-years). Hemodynamic evaluation , by serial echocardiography, was performed at four and 18 months after imp lantation. Results: The early mortality rate was low (0.8%). Mean (+/- SD) actuarial s urvival at 53 months was 78 +/- 5.9%, with most patients (91%) in NYHA clas ses I and II. Freedom from valve-related complications were: endocarditis 9 3.8 +/- 2.3%, thromboembolism 90.3 +/- 3.7% and bleeding 95.8 +/- 1.8%; the re were no structural failures. The valve hemodynamic profile was excellent for all sizes: peak gradient 8.8 +/- 4.3 mmHg, effective orifice area 1.9 +/- 0.54 cm(2) with significant improvement in left ventricular fractional shortening. Conclusion: In this patient population the Toronto SPV was a suitable choic e. Advanced age, a requirement for concomitant procedures and increased isc hemic times did not adversely affect surgical risk. AVR with the Toronto SP V provided an excellent hemodynamic profile, and improved both left ventric ular function and NYHA functional class.