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J Thorac Cardiovasc Surg 1998;116:236-240
© 1998 Mosby, Inc.

Surgery for Adult Cardiovascular Disease

Aortic valve replacement with stentless and stented porcine valves: a case-match study

From the Divisions of Cardiovascular Surgery of The Toronto Hospital and the University of Toronto, Toronto, Ontario, Canada.

Received for publication Feb. 13, 1998. Revisions requested March 26, 1998; revisions received April 13, 1998. Accepted for publication April 13, 1998. Address for reprints: Tirone E. David, MD, 200 Elizabeth St.—13EN219, Toronto, Ontario, Canada M5G 2C4.

Objectives: To assess the potential benefits of the hemodynamic superiority of stentless valves, we conducted a case-match study among patients who underwent aortic valve replacement with two types of porcine bioprostheses: the Toronto SPV and the stented Hancock II bioprosthesis.
Methods: Preoperative clinical variables predictive of death after aortic valve replacement were determined by a stepwise logistic regression analysis in a series of 908 consecutive patients who received porcine aortic bioprostheses during a 14-year interval. Advanced age, New York Heart Association functional class IV, left ventricular ejection fraction of less than 30%, and coronary artery disease were independent predictors of death. On the basis of these four variables, 198 pairs of patients who survived aortic valve replacement with stentless and stented porcine valves were matched. The follow-up, truncated to the shortest interval for each matched pair, was 43 ± 24 months for both groups.
Results: At 8 years the actuarial survival was 91% ± 4% for the Toronto SPV group and 69% ± 8% for the Hancock II group (p = 0.006); the freedom from cardiac-related death was 95% ± 4% for the Toronto SPV and 81% ± 8% for the Hancock II (p = 0.01); the freedom from any valve-related complication was 81% ± 5% for the Toronto SPV and 50% ± 10% for the Hancock II (p = 0.008). A Cox proportional hazard model demonstrated a significant reduction in cardiac mortality rates and valve-related morbidity in patients who received the Toronto SPV bioprosthesis.
Conclusions: Although it is possible that confounding factors may have played a role in the clinical outcomes of this case-control study, the study suggests that aortic valve replacement with a stentless porcine valve enhances survival. This is believed to be due to the hemodynamic superiority of these valves.

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