Experiences with the Toronto SPV bioprosthesis after three years follow-up.

BACKGROUND

Stentless aortic valve prostheses are considered to be hemodynamically superior to mounted bioprostheses. The Toronto SPV bioprosthesis is a Dacron covered stentless porcine aortic prosthesis.

METHODS

From March 1993 to October 1997, 175 patients underwent aortic valve replacement with the Toronto SPV bioprosthesis, 126 patients with leading aortic stenosis, 14 with valve insufficiency, and combined lesion in 35 patients. Preoperatively all patients were in NYHA class III-IV. All patients underwent transesophageal echocardiography (TEE) intraoperatively after institution of cardiopulmonary bypass (CPB). The patients underwent clinical and echocardiographic examinations at 1 week, 6 months, 12 months, 24 months, and 36 months postoperatively.

RESULTS

Mean age was 71.3 years (range 29-84). Additional coronary artery bypass grafting (CABG) was performed in 74 patients. Mean ischemic time was 58 minutes (range 49-129) for singular aortic valve replacement (AVR) and 86 minutes (range 66-136) with additional CABG. The 30-day mortality was low at 4% (7/175). 139 patients were seen at 2 years and 77 at 3 years follow-up. At 3 years 67% (51/77) of our patients were in NYHA functional class I and 33% (26/77) were in class II. Minimal aortic valve incompetence was seen in 17% (13/77) at 3 years.

CONCLUSIONS

The Toronto SPV bioprosthesis shows good results both hemodynamically and clinically. Most patients are in NYHA functional class I or II after 3 years. Perioperative mortality was low and no valve-related complications occurred.