Leaflet Replacement for Aortic Stenosis Using the 3f Stentless Aortic Bioprosthesis: Midterm Results

Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany.
The Annals of thoracic surgery (Impact Factor: 3.85). 02/2012; 93(4):1134-40. DOI: 10.1016/j.athoracsur.2012.01.010
Source: PubMed


The 3f aortic bioprosthesis is a stentless valve resembling the native aortic valve. It has been postulated that improved hemodynamic performance with this prosthesis may translate into superior durability. We hereby report the midterm results using this valve substitute.
Fifty patients with severe aortic stenosis received the 3f aortic bioprosthesis between 2002 and 2004 in our unit. Clinical outcomes, effective orifice area, mean gradients, and ejection fraction were evaluated at discharge, at 6 and 12 months, and yearly thereafter.
Mean follow-up was 52 ± 10 months and was complete in 96% of surviving patients. Hemodynamic performance of the 3f valve was satisfactory for substitutes in the range of 25 mm and 27 mm; smaller valve substitutes showed unfavorable hemodynamic performance with mean gradients of 18 ± 7 mm Hg for 21-mm prosthesis, and 14 ± 5 mm Hg for 23-mm prosthesis. Consequently, the regression of left ventricular hypertrophy was incomplete. Late mortality included 10 patients (valve-related in 1, cardiac-related in 3) for a survival of 77% ± 3% at 4 years. Four patients required reoperation owing to endocarditis in 2 and paravalvular leak in other 2. Freedom from reoperation was 93% at 4 years. Six patients experienced 9 neurologic events, accounting for 82% freedom from neurologic events.
Its unique design makes the 3f aortic bioprosthesis less complex to implant than conventional stentless valves, as only a single suture line is necessary. The hemodynamic profile and clinical performance of the prosthesis are inconsistent with the established stentless valves, especially with regard to higher incidence of neurologic complications seen during the follow-up.

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