40. AORTIC VALVE REPLACEMENT WITH FREESTYLE OR TORONTO VALVES: AN EARLY COMPARISON OF TWO STENTLESS BIOPROSTHESES.
Robert D. Riley, John W. Hammon*, Neal D. Kon*
Wake Forest University School of Medicine
Winston-Salem, North Carolina, USA
BACKGROUND
Stented bioprostheses have limited durability and obstructive flow patterns. We have implanted two new stentless bioprostheses; the Medtronic Freestyle Aortic valve (FAV) and the St. Jude Medical Toronto (SPV). Early results are compared over a similar time interval implanting both types of aortic valves.
MATERIAL AND METHODS
From May 1997 to May 1999, 14 SPV bioprostheses were implanted in the subcoronary position. Forty-four FAVs were implanted using a total root replacement technique. Sixty-four percent of both groups (9/14 SPV and 28/44 FAV) underwent concurrent procedures. Average ischemic time was 2 hours and 3 minutes for the SPV implant and 1 hour and 57 minutes for the FAV root replacement. Echocardiographic evaluation was routinely performed prior to hospital discharge and at 6 months follow-up.
RESULTS
Perioperative mortality was 7% (1/14) for the SPV group and 2% (1/44) for the FAV group. Thromboembolic complications (TIAs) were 7% (1/14) vs 2% (1/44). Six-month echo data demonstrated SPV aortic valve area 1.5cm2
± 0.38 vs FAV aortic valve area 1.7cm2± 0.4; SPV mean aortic valve gradient 13.4 mmHg± 3.2 vs FAV mean aortic valve gradient 7.9 mmHg± 4.1, respectively. SPV aortic regurgitation (AR) at 6 months was graded as none to trace 57% (4/7), mild 28% (2/7), and moderate 14% (1/7). All FAVs were graded as zero or trace AR.CONCLUSION
Both the SPV and FAV offer improved hemodynamics vs traditional heart valves. Root replacement technique with the FAV had less AR without increasing operative time, morbidity or mortality.
