Clinical Analysis of Stentless Porcine Aortic Bioprosthesis: An Update
Mario Vrandecic MD, Fernando Antonio Fantini MD, Bayard Gontijo Filho MD, Ozanan César de Oliveira MD, Idail Martins da Costa Júnior MD, Erika Vrandecic MD

An update of long-term results with porcine composite stentless valves is presented; the analysis focused on valve hemodynamics, patient survival and trend towards structural valve degeneration. Between 1990 and 2001, 247 patients underwent aortic valve replacement. Mean follow up was 5.9 ± 2.8 years (range: 1 month to 11.4 years); total follow up was 1,392 patient-years (97.7% complete). Hospital mortality was 4% and late mortality 6.1%. There were three reoperations (1.2%) due to paravalvular leak and endocarditis; none was related to structural valve failure. Hemodynamic benefits included larger aortic effective orifice area (1.71 cm²), lower peak and mean transvalvular gradients and reduction of left ventricular mass index, from 174 g/m² preoperative to 117 g/m² postoperative. At study end, most patients (90.2%) were in NYHA classes I or II. Actuarial survival was 91.3%; freedom from reoperation was 98.5%. Sequential echo-Doppler follow up disclosed the presence of mild and slowly appearing structural valve changes without affecting excellent valve performance. Longer follow up is required to confirm continued benefits.