Abstract 4785: Comparison Of Long-term Clinical Outcomes Following Aortic Valve Replacement With Homografts And Porcine Stentless Valves
The porcine stentless valve was designed to emulate the hemodynamic performance of the homograft. Early outcomes using either surgical option have been similar. However, long-term outcomes remain to be compared. In this study we evaluated clinical outcomes up to 10 years following AVR. Demographic, operative, and clinical data were obtained retrospectively through casenote review. Actuarial survival and freedom from re-operation were determined using the Kaplan-Meier product limit method and compared using the log rank test. Cox proportional hazards regression was used to identify independent predictors of re-operation and late survival. Between 1st January 1991 and 1st January 2001, 415 patients underwent AVR. 217 patients received a homograft and 198 were implanted with a Toronto stentless porcine valve (TSPV). Mean time to follow-up was 6.3 ± 4.1 years. Patients receiving a homograft were significantly younger (TSPV 67 ± 20 yrs vs. homograft 61 ± 7 yrs), p < 0.001 and were less likely to require concomitant CABG (TSPV 40% vs. homograft 19 %), P < 0.001. Freedom from re-operation was not significantly different at 10 years (TSPV 80% ± 4 vs. homograft 85% ± 4), p = 0.61. The TSPV was associated with significantly worse long-term survival than the homograft (TSPV 40% ± 4vs. homograft 55% ± 4), p = 0.02. However, after adjustment for other variables (using a multivariate model), TSPV use was not an independent predictor of impaired late survival (P = 0.44). Independent predictors of impaired survival were redo operation (P = 0.009), concomitant CABG (P < 0.001), age >70 (P < 0.001), poor LV function (P = 0.01) and emergency operation (P = 0.02). Previous redo operation (0.003) and age (P<0.001) were independent predictors for re-operation. The porcine stentless valve is associated with similar clinical outcomes to the homograft over the long-term. In the face of limited homograft availability, stentless valves are an excellent alternative with comparable clinical performance and long-term durability.