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J Thorac Cardiovasc Surg 1998;116:477-481
© 1998 Mosby, Inc.
Surgery for Adult Cardiovascular Disease |
From the Department of Cardiac Surgery, Oxford Heart Centre, The JohnRadcliffe Hospital, Oxford, United Kingdom.
Received for publication Jan 22, 1998. Revisions requested April 8, 1998; revisions received April 24, 1998. Accepted for publication June 2, 1998. Address for reprints: Stephen Westaby, BSc, FRCS, MS, Oxford HeartCentre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UnitedKingdom.
Objective: Stentless valves conveyimportant hemodynamic benefits but are used selectively depending on aortic rootstructure. The Freestyle valve (Medtronic, Inc, Minneapolis, Minn) is aversatile device that can be implanted by different methods depending onoperating conditions. We aimed to demonstrate that a stentless valve could beused in every patient without increased risk of morbidity or mortality. Wedocumented the effects of this valve on clinical outcome and left ventricularmechanics.
Methods: The Freestyle valvewas implanted by the modified subcoronary method into 200 consecutive unselectedpatients who received a tissue valve in the aortic position and by rootreplacement in 2. Forty-three percent were older than 75 years. Forty percentunderwent coronary bypass. Detailed clinical and echocardiographic follow-up(Food and Drug Administration protocol) was used out to 3 years.
Results: Mean ischemic time was 43 ± 6 minutes forisolated aortic valve replacement and 63 ± 14 minutes with concomitantprocedures. Thirty-day mortality was 6%, none of the deaths being valverelated. Hemodynamic function improved progressively with falling valvegradients and increased effective orifice areas. Left ventricular mass fellwithin normal limits over 2 years, but at 3 years there was a non-valve-relatedupswing. No instances of valve thrombosis, hemolysis, or paravalvular leak werenoted. Less than 5% had mild to moderate aortic regurgitation.
Conclusions: The Freestyle valve can be used in virtuallyevery patient with aortic valve disease and provides superlative hemodynamicoutcome. Hospital mortality and morbidity are similar to those reported forstented valves in an elderly population. (J Thorac Cardiovasc Surg1998;116:477-84)
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