Short Term Outcomes of Aortic Valve Replacement Using a New Stented Pericardial Bioprosthesis

Abstract

Objective: Development of stented bioprostheses have been evolving through several decades to improve performance and durability. A new pericardial bovine valve has been recently approved and released. This was introduced in our institution in December 2018. We report our single institution early results in 45 patients. Methods: The hospital cardiac surgery database (PATS & EPR) was retrospectively reviewed. Characteristics and outcomes, including mortality, post-operative complications together with echocardiographic findings are reported. Results: Between December 2018 and October 2020, n=45 patients underwent aortic valve replacements and had an Avalus tissue valve implanted. 28 of 45 patients had aortic valve stenosis, 6 had aortic regurgitation and 11 mixed aortic valve disease. Median age was 75yrs (range=49-83yrs), ventricular function was good in n=40 patients, moderate in n=3 patients, poor in n=2 patients. Aortic valve replacement was first time surgery in all of our patients, with one case of urgent infective endocarditis. 19 patients out of 45 had concomitant procedures: n=9 CABG, n=1 MVR, n=2 ascending aorta replacement, n=5 AF ablation, n=1 AF ablation + MVR, n=1 AF ablation + CABG. Valve sizes were: n=2 21mm, n=13 23mm, n=19 25mm, n=10 27mm, n=1 29mm. We had one in-hospital mortality not valve related, one case of re-exploration for bleeding and no valve related complications (thromboembolism, thrombosis, significant paravalvular leak, endocarditis, haemolysis, structural valve deterioration). All the patients had a pre-discharge echocardiogram which showed a mean gradient range=2-18mmHg (median=10mmHg) and peak gradient range=5-31mmHg (median 19.05mmHg). At 30 days follow up (41/45) all the patients reviewed were classified on NYHA class < 2, except one readmission for fast AF in an 80yrs of age female patient. Conclusions: Our short-term experience with Avalus bioprosthesis demonstrated it to be safe, with low mortality or valve related complications and good haemodynamic performance.