Degeneration of Pericardial Aortic Valve Biological Prostheses in Correlation with Age Decades and Different Types of Prostheses - Long Term Follow-up Results

Abstract

Objectives: Currently trends are moving toward the use of bioprosthetic valves in the aortic position in younger patients to avoid lifelong anticoagulation therapy. This study examines the long-term durability associated with structural valve degeneration (SVD) of three pericardial bioprostheses in the aortic position considering patients' age and preoperative characteristics. Methods: From 2004 to 2014, 1506 consecutive patients underwent aortic valve replacement (AVR) with either a Sorin Mitroflow (n = 815; 54,1%; M-group), Edwards Lifesciences Perimount (n = 614; 40.8%; P-group) or Sorin Freedom Solo (n = 77; 5.1%; S-group) pericardial bioprosthesis at our institution. Freedom from SVD and reoperation were studied according to the 3 different bioprosthesis and age group. Mean age at time of surgery was 73.7 ± 7.7 years for Mitroflow, 64.1 ± 11.8 years for Perimount, and 69.5 ± 11.3 years for Solo bioprosthesis, respectively. Mean follow-up was 4.7 ± 5.3 years (range 0–10.3 years) and was 100% complete. Results: Overall survival was 86.8% (at 5-year/10-year follow-up 84.9%/83.8% in the M-group, 94.5%/91.7% in the P-group and 80.5%/79.2% for the S-group). A total of 199 (13.2%) patients died during follow-up, 132 (16.2%) patients in the M-group, 51(8.3%) patients in the P-group, and 16 (20.8%) patients in the S-group (p< 0.001). The overall number of valve-related deaths was 16 (8.04%) - 8 patients (6.06%) were from the M-group, 3(5.088%) from the P-group and 5 (31.25%) patients from the S-group (p< 0.001). Overall, 77 patients underwent reoperation, with 55 (71.4%) cases related to SVD and 19 (24.7%) cases related to endocarditis. Freedom from re-operation after 5/10 years was 93.1%/92.6% in the M-group, 98.7%/98.4% in the P-group and 93.5%/90.9% in the S-group, respectively. 81.7% of all Mitroflow re-operations were due to SVD, 40% of all Perimount and 28.6% of all Solo, respectively (p< 0.001). Endocarditis occurred in 18.3% of all re-operations in the M-group, 40% in the P-group, and 57% in the S-group, respectively (p< 0.001). Conclusions: Long-term survival was significantly different among groups with higher rate of survival for Mitroflow and Perimount prostheses. Long-term freedom from re-operation was significantly different among groups with a higher rate of re-operation in Mitroflow and Solo prostheses. The significant majority of re-operation in Mitroflow prostheses was due to SVD, in Solo prostheses due to endocarditis.