Aortic valve replacement with the Toronto SPV: long-term clinical and hemodynamic results (original) (raw)
Related papers
Stentless aortic valve replacement with freestyle or Toronto SPV: an early comparison
The Annals of Thoracic Surgery, 2000
comparison Stentless aortic valve replacement with freestyle or Toronto SPV: an early http://ats.ctsnetjournals.org/cgi/content/full/70/1/48 on the World Wide Web at: The online version of this article, along with updated information and services, is located Print ISSN: 0003-4975; eISSN: 1552-6259. Southern Thoracic Surgical Association. Background. Stentless aortic xenograft valves have been developed to overcome the disadvantages of conventional stented prostheses. We have implanted two new aortic bioprostheses: the Medtronic Freestyle and the St. Jude Toronto SPV. Early results are compared. Methods. Forty-four Freestyle valves were implanted using a freestanding total root technique. Fourteen subcoronary Toronto SPV bioprostheses were implanted. Sixty-four percent of both groups (28 of 44 Freestyle and 9 of 14 Toronto SPV) underwent concurrent procedures. Results. Ischemic time was 117 ؎ 21 minutes for Freestyle and 124 ؎ 19 minutes for Toronto SPV. There were no operative deaths or valve-related reoperations. Aortic valve area was 1.83 ؎ 0.51 cm 2 for Freestyle and 1.80 ؎ 0.51 cm 2 (p ؍ 0.89) for Toronto SPV. Transvalvular gradient was 8.03 ؎ 4.09 mm Hg for Freestyle and 12.4 ؎ 1.82 mm Hg (p ؍ 0.002) for the Toronto SPV. Aortic regurgitation was not experienced in any Freestyle patients, while Toronto SPV patients were graded as none to trace 79% (11 of 14), mild 14% (2 of 14), and moderate 7% (1 of 14).
The stentless Toronto SPV bioprosthesis for aortic valve replacement
Cardiovascular Surgery, 1996
The TorontoSPVbioprosthesis for aorticvalvereplacement hasbeenprospectively evaluated .in 100 patients,sinceMarch 1993. Intraoperative transoesophageai andpostoperative trans~horacic echocardiography were used to assessvalve function. Follow-upwas completein 74 patients at 6 months and in 38 patients at 1 year. The averagevalve size implantedwas 26.5 mm. Some37 patientshadadditional coronaryarterybypassgraftingsurgery. Thehospital mortality rate was 49fo. Non-structuralvalve dysfunctionoccurredin one patient and late endocarditisin anotherpatient requiredoperation.There were no other valvecomplications. Noneof the patientsdeveloped clinically relevantaorticvalveincompetence duringfollow-upand there was a significantdecreasein pressuregradients, increasein valve orifice areas and decreasein left ventricular hypertrophy.
The Journal of heart valve disease
Stentless aortic bioprostheses have excellent hemodynamics. Previous investigations of the Toronto SPV valve described a correlation between the occurrence of significant aortic regurgitation (AR) and dilation of the sinotubular junction. The study aim was to determine the long-term durability and determinants of AR at nine years in a large, multicenter study of the Toronto SPV valve. The study included 447 patients from six centers. Clinical outcomes and echocardiographic data (gradients, effective orifice area index (EOA-I), left ventricular mass, aortic root dimensions, and presence and severity of AR) were collected prospectively. A multivariable logistic regression model was used to evaluate clinical and echocardiographic variables for impact on the occurrence of AR. Total follow up was 2,660 patient-years (mean 6.0 +/- 2.5 years; range: 0 to 11.1 years). Mean gradient and EOA-I remained unchanged through nine years. There were 17 cases of structural deterioration, of which 15 ...
Long-Term Valve Performance of TAVR and SAVR: A Report From the PARTNER I Trial
JACC. Cardiovascular imaging, 2016
The aim of this study was to evaluate the long-term performance of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) through longitudinal echocardiographic analysis. The long-term performance of the SAPIEN TAVR is not well-described. Therefore, we examined the hemodynamic and valvular profile of the SAPIEN TAVR over 5 years. All patients receiving TAVR or SAVR with first post-implant (FPI) and 5-year echoes were analyzed for aortic valve (AV) peak velocity, AV mean gradient, AV area, peak left ventricular (LV) outflow tract and in-stent velocities, Doppler velocity index, aortic regurgitation (AR), LV mass index, stroke volume index, and cardiac index. The FPI and 5-year data were compared using a paired t test or McNemar's analyses. There were 86 TAVR and 48 SAVR patients with paired FPI and 5-year echocardiograms. Baseline characteristics were similar between groups. The AV area did not change significantly 5 years after TAVR (p = 0.35)...
Aortic valve replacement with stentless and stented porcine valves: a case-match study
The Journal of Thoracic and Cardiovascular Surgery, 1998
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.
Hemodynamic benefits of the Toronto stentless valve
The Journal of Thoracic and Cardiovascular Surgery, 1996
We report on 254 consecutive patients (170 male, 84 female) undergoing aortic valve replacement with the Toronto SPV Stentless Valve (St. Jude Medical, Inc., St. Paul, Minn.). Mean age (-standard deviation) was 62.1 -11.6 years. Three patients (1%) received sizes 21 or 22 mm, 24 (9%) received size 23 mm, and 227 patients (89%) received sizes 25, 27, or 29 mm. Serial echocardiography was used to assess valve performance during a 3-year follow-up. Mean gradient decreased by 35.8% (p < 0.0001; 95% confidence interval -39.6%, -31.7%) from postoperative values to the 3-to 6-month follow-up and by 6.1% (p = 0.004; 95% confidence interval -10.1%, -2%) at each subsequent interval; effective orifice area increased by 17.2% (p --0.0001; 95% confidence interval 12.0%, 22.6%) initially and by 4.4% (p < 0.001; 95% confidence interval 1.8%, 7.0%) thereafter. At 2 years of follow-up, mean gradient was 3.3 -+ 2.1 mm Hg and mean effective orifice area was 2.2 _ 0.8 cm 2. Studies on left ventricular mass were carried out on 84 patients. Left ventricular mass decreased by 14.3% (37.8 ---57.9 gm; p < 0.0001; 95% confidence interval --53,7, -21.9 gin) and left ventricular mass index decreased by 15.2% (21.1 -30.5 gm/m2; p < 0.0001; 95% confidence interval -29.5, -12.7 gm/m 2) from postoperative values to the 3-to 6-month follow-up interval. The reduction in residual gradient and potential regression in left ventricular hypertrophy may have a beneficial prognostic implication. We believe that the unique stenfless design of the Toronto SPV Stentless Valve allows this to occur. (J Thorac
The Annals of Thoracic Surgery, 2005
The Kay-Shiley valve in the current report is the model without muscle guard. Previous studies reported high incidences of thromboembolic complications with the Kay-Shiley disc valve. Wellons and colleagues [2] reported complications totaling 55 embolic events in 83 patients over a 6-year period. Bowen and colleagues [3] noted complications in 64% of the operative survivors with an incidence of 28.7 events per 1,000 patient months. Bowen and colleagues [3] recommended elective replacement of the Kay-Shiley mitral prostheses in all patients in whom the risk of operation was reasonable.